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研究生:陳嘉惠
研究生(外文):Chia-hui Chen
論文名稱:穴位按摩對減輕產後母嬰分離哺乳婦女乳房腫脹之成效
論文名稱(外文):Efficacy of Acupressure on Breast Engorgement during Breast--feeding in Postpartum Mothers
指導教授:陳秋媛陳秋媛引用關係
指導教授(外文):Chiu-yuan Chen
學位類別:碩士
校院名稱:南華大學
系所名稱:自然醫學研究所
學門:醫藥衛生學門
學類:其他醫藥衛生學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:86
中文關鍵詞:乳房腫脹穴位按摩產後母嬰分離母乳哺餵
外文關鍵詞:breast engorgementacupressurenon-rooming-in carebreast-feeding
相關次數:
  • 被引用被引用:0
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  • 下載下載:207
  • 收藏至我的研究室書目清單書目收藏:1
  背景及目的:世界衛生組織呼籲,哺餵母乳是提供新生兒營養最理想的方式,建議純母乳哺餵需達嬰兒六個月,當嬰兒六個月後添加營養補充食品後繼續哺餵母乳可長達兩年或更久。哺餵母乳好處甚多,但哺餵母乳過程中,乳房腫脹導致的疼痛是許多哺乳婦女放棄繼續哺乳之主要原因。乳房腫脹的一般處理方法為鼓勵儘早開始哺乳及增加哺乳次數,但母嬰分離之產婦因嬰兒吸吮次數不夠,無法有效改善乳房腫脹疼痛,減少母乳哺餵意願。中醫穴位按摩是藉由穴點按壓以達疏通經絡,可促進乳汁排出,減輕脹乳疼痛。本研究目的即在探討穴位按摩法對減緩母嬰分離之產婦乳房腫脹疼痛之成效。
 
  方法:本研究共招募60位嘉義某區域教學醫院產後護理之家採母嬰分離併有乳房腫脹之產婦,隨機分派分為實驗組與對照組,每組各30人。兩組受試者填寫個別之同意書,以排除受試者安慰劑效應。產後3-5天起實施介入措施,每天一次,連續三天。實驗組以穴位按摩法為介入方案,依據中醫穴位按摩手法,於乳房周圍俞穴屋翳、膺窗、乳根、膻中進行穴點按壓,接著以一般護理步驟將乳汁擠出。對照組僅以一般護理步驟將乳汁擠出。評量工具為個案脹奶症狀自覺評量表、脹奶生理狀況評估表及基本資料量表。介入措施皆由研究員本人以固定的手法及力道進行介入,脹奶症狀評量表由另一位護理人員協助受試者填寫。以Excel 2007及SPSS 18套裝軟體進行資料統計分析。以獨立樣本t檢定及卡方檢定比較人口學資料;以成對樣本t檢定及獨立樣本t檢定分析內各組組內及組間之平均值差異;以廣義估計方程式GEE檢定脹奶程度與基本屬性之相關性。最後以Fisher’s精確檢定比較介入後脹乳不適之追蹤分析。
 
  結果:兩組人口學資料未達顯著差異性。兩組於第一天、第二天及第三天,介入後5分鐘及30分鐘之自覺乳房疼痛程度、自覺乳房腫脹程度、自覺乳房發熱程度及自覺乳房不舒適程度與介入前相比有顯著差異 (p < 0.001)。實驗組與對照組之前後測組間比較,實驗組較對照組有顯著成效 (p < 0.001)。將人口學變項加入為共變數進行分析,其差異亦未改變,因此排除其影響。於介入結束後一個月電話追蹤訪問結果發現,實驗組全數表示無乳房疼痛現象,對照組則有39.3%表示仍有乳房疼痛現象;3.3%實驗組有局部腫塊,對照組則為53.6%。
 
  結論:穴位按摩是一種安全及經濟的自然療法,對減輕產婦乳房腫脹成效顯著,日後可加以推廣穴位按摩,以幫助更多哺乳婦女成功哺餵母乳。本研究結果可作為產科乳房腫脹護理之參考。
  Background and purpose: The World Health Organization (WHO) recommends that breastfeeding is the best ideal method to provide newborns with nutrients. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods for up to two years of age or beyond. There are many advantages of breastfeeding. However, the pain caused by breast engorgement is one of the reasons women discontinue breastfeeding. The general management of breast engorgement is to encourage early breastfeeding and increase breastfeeding frequency. However, non-rooming-in mothers are unable to relieve breast engorgement due to low suction frequency. The pain caused by breast engorgement discourages mothers to keep breastfeeding. Acupressure has the effect of removing obstructions from meridians to facilitate breast milk ejection, and reduce pain caused by breast engorgement. The purpose of this study is to determine the effect of acupressure to relieve breast engorgement.
 
  Methods: A randomized controlled trial was conducted on 60 postpartum non-rooming-in women in a postpartum care center at a Chiayi regional teaching hospital. Participants had been randomized equally to experimental and controlled group (each group had 30 persons). The member of each group signed the different kind of agreement to make sure they didin’t know another intervention ,to avoid placebo effect .In the experimental group, the women received acupressure and hand expression of breast milk daily for 3 days. The acupoints were 屋翳 (Wu-Yi, ST15) , 膺窗 (Ying-Chuang, ST16) , 乳根 (Ru-Gen, ST17) and 膻中 (Dan-Zhong, CV17). In the control group, the women proceeded with only hand expression of breast milk. The assessment of the subjects included recording their basic characteristics, completion of a subjective breast engorgement scale, and physiological measurements. Interventions was performed by the same researcher with the same approach and strength. Another nurse help the participants to fill the engorgement symptoms rating scale. All data collected were analyzed with Microsoft Excel 2007 and SPSS Version 18. Paired-samples t-test, independent t-test and Chi-Square test were used to evaluate differences in basic characteristics and outcome indicators. Generalized estimating equation (GEE) models were used to determine relationships between breast engorgement and basic characteristics. Data were again collected one month after intervention, and were subjected to Fisher’s exact test analysis.
 
  Results: The basic characteristics of subjects in the two groups were homogeneous. In both groups, there were significant statistical differences (P < 0.001) in the extent of breast engorgement, subjective breast pain, and subjective breast discomfort at 5 minutes and 30 minutes after intervention on the 1st, 2nd and 3rd day postpartum. Comparisons between the experimental group and the control group showed significant improvements (P < 0.001) in all outcome indicators. After including the basic characteristics of subjects into the analysis, no significant changes in the results were found. Furthermore, results obtained from the data collected one month after intervention showed that subjects in the experimental group experienced no breast pain. In contrast, 39.3% of subjects in the control group experienced intermittent breast pain. Moreover, 3.3% and 53.6% of subjects in the experimental group and control group, respectively, experienced localized breast engorgement.
 
  Conclusion: Acupressure had significant effects in reducing breast engorgement. It should be promoted to help lactating women to breastfeed successfully. The results of the present study can be used as a reference for postpartum breast engorgement care.
摘 要 I
ABSTRACT III
目 次 VI
表目次 X
圖目次 XI
 
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 3
1.3 研究目的 4
 
第二章 文獻回顧 5
2.1 哺餵母乳之益處 5
2.1.1 對嬰兒方面 5
2.1.2 對母親方面 6
2.2 各國哺餵母乳現況分析 7
2.3乳房腫脹之成因及護理 11
2.3.1 西醫之觀點 11
2.3.2 中醫之觀點 12
2.4穴位按摩 17
2.4.1穴位按摩之作用機轉 18
2.4.2穴位按摩之臨床應用 19
2.4.3乳房腫脹相關穴位 20
 
第三章 研究方法 23
3.1 研究設計 23
3.2 研究流程 24
3.3 研究對象及隨機分配 26
3.4 研究場所 27
3.5 量測工具 27
3.6 介入方法 29
3.7 後續追蹤 30
3.8 統計分析 30
 
第四章 研究結果 31
4.1 受試者之人口學資料及生理參數分析 31
4.1.1 受試者人口學資料 31
4.1.2 受試者前測之生理參數比較 35
4.2 介入前後受試者乳房腫脹之差異 37
4.3穴位按摩對受試者乳房腫脹之成效 39
4.3.1 穴位按摩對受試者自覺疼痛改善程度 39
4.3.2 穴位按摩對受試者自覺腫脹改善程度 42
4.3.3 穴位按摩對受試者自覺乳房發熱改善程度 44
4.3.4穴位按摩對受試者自覺乳房不舒適改善程度 46
4.4 受試者人口學資料與脹乳不適之相關性 48
4.5 受試者介入後脹乳不適之追蹤分析 53
4.6 介入前後受試者體溫及乳房溫度變化 55
 
第五章 討論 57
5.1 人口學之分析 57
5.2 穴位按摩法對減輕產後婦女脹奶之成效 60
 
第六章 結論 64
 
第七章 研究限制及建議 65
 
參考文獻 67
 
附 錄 78
附錄A 臨床試驗研究計畫同意書 78
附錄B 基本資料問卷 79
附錄C 脹奶生理狀況評估表 81
附錄D 脹奶症狀自覺評量表(執行前) 82
附錄E 脹奶症狀自覺評量表(執行後5分鐘) 83
附錄F 脹奶症狀自覺評量表(執行後30分鐘) 84
附錄G 評量表授權同意書 85
附錄H 隨機分配表 86
 
表目次
表 4.1.1 受試者人口學資料比較 32
表 4.1.2 受試者前測之生理參數 35
表4.1.3 兩組血壓、脈搏及呼吸之差異 36
表 4.2 實驗組及對照組之VAS前後測比較 38
表4.3.1 穴位按摩對受試者自覺疼痛改善程度 41
表4.3.2 穴位按摩對受試者自覺腫脹改善程度 43
表4.3.3 穴位按摩對受試者自覺乳房發熱改善程度 45
表 4.3.4 穴位按摩對受試者自覺乳房不舒適改善程度 47
表4.4.1 兩組人口學資料與乳房疼痛之相關性 49
表4.4.2 兩組人口學資料與乳房腫脹之相關性 50
表4.4.3 兩組人口學資料與乳房發熱之相關性 51
表4.4.4 兩組人口學資料與乳房不舒適之相關性 52
表4.5.1 兩組第一個月電話訪問分析 54
表4.6.1 體溫及乳房溫度之差異 56
 
圖目次
圖1 穴位圖示 22
圖2 研究流程圖 25
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