對接受根管治療的病患而言，疼痛與焦慮是相當令人困擾的經驗。國際疼痛研究學會定義疼痛為一種不舒服的感官與情緒經驗。疼痛與焦慮經驗隨著治療過程各階段產生變化，也受到患者的情緒以及認知因素的影響。本研究旨在探討接受緊急根管治療患者之疼痛與焦慮經驗，我們觀察35位於台北榮民總醫院接受緊急根管治療之帶症狀不可逆牙髓炎患者，記錄其治療時各階段疼痛程度、焦慮程度以及疼痛緩解程度，並探討過去接受牙科治療的經驗、情緒以及認知因素與疼痛經驗的關聯性。研究證據顯示成功的緊急根管治療不但能減緩疼痛（平均疼痛分數由7.3±1.7分下降至1.8±1.3分，總分10分），也能有效改善病患的焦慮情緒（平均焦慮分數由6.1±3.2分下降至1.2±1.5分，總分10分）。患者預期治療後的疼痛緩解程度與其實際感受的疼痛緩解程度一致。病患治療前的疼痛以及焦慮程度與過去接受治療的疼痛以及焦慮經驗呈顯著的正相關性。而病患的疼痛恐懼與治療後的疼痛程度有顯著的關聯性。以上證據將有助於臨床醫師進一步了解緊急根管治療病患之疼痛與焦慮程度的變化，並突顯情緒與認知因素在病患治療經驗中的重要性。

For the patients receiving endodontic treatment, pain and anxiety is a very common unpleasant experience. According to the International Association for the Study of Pain, pain is an unpleasant sensory and emotional experience. Pain experience may change dynamically throughout the course of endodontic treatment, and it is associated with patients’ emotional and cognitive factors. The thesis aimed to investigate pain and anxiety of patients receiving endodontic emergency treatment. We investigated 35 patients with symptomatic irreversible pulpitis received endodontic emergency treatment at the clinic of Endodontics and Periodontology Division, Department of Stomatology, Taipei Veterans General Hospital. Their pain, anxiety and pain relief at different time points were assessed during treatment. We investigated the association between past dental experiences, emotional/cognitive factors and pain experiences of endodontic emergency treatment. We found that both pain and anxiety effectively relieved after treatment. The degree of pain relief that the patients anticipated before the treatment was consistent with the actual pain relief after treatment. Patients’ pre-treatment pain and anxiety was significantly positively correlated with their pain and anxiety related to prior experience of dental treatments. Furthermore, patients’ post-treatment pain was significantly correlated with their fear of pain. The findings would contribute to our understanding about the changes of pain and anxiety experience of patients receiving endodontic emergency treatment, and highlight the roles of emotional and cognitive factors in patients’ dental experience.

目錄
謝辭 i
中文摘要 ii
英文摘要 iii
目錄 iv
圖目錄 ix
表目錄 x
附件 xi
第一章 研究背景與目標 1
1.1 研究背景 1
1.2 研究目標 2
1.2.1 子目標一：探討不可逆牙髓炎不同治療階段的變化 3
1.2.2 子目標二：探討過去接受牙科治療的經驗與本次治療疼痛經驗的關聯性 3
1.2.3 子目標三：探討情緒與認知因素與治療疼痛經驗的關聯性 3
1.3 主要研究變項與定義 4
1.4 文獻回顧 4
1.4.1 文獻回顧主題 5
1.4.2資料收集 5
1.4.3採用文獻標準 5
1.4.4 資料整理 6
1.4.5 系統性文獻回顧結果 6
1.4.6 其他牙科治療之文獻回顧 8
1.4.7 過去文獻回顧對本研究之啟發 10
1.5 研究假設 12
1.5.1 子目標一：探討不可逆牙髓炎不同治療階段的變化 12
1.5.2子目標二：過去接受牙科治療的經驗與本次治療疼痛經驗的關聯性 13
1.5.3 子目標三：探討情緒與認知因素與治療疼痛經驗的關聯性 13
第二章 研究方法 14
2.1 實驗設計 14
2.2 研究對象與收案流程 14
2.2.1 研究對象 14
2.2.1.1 病患受試者 14
2.2.1.2 健康（非牙痛）受試者 15
2.2.2 收案流程 15
2.3 研究倫理 16
2.4 受試者最小樣本數估計 16
2.4.1 相關性分析之最小樣本估計 16
2.4.2比較組間差異之最小樣本數估計 17
2.5 研究工具 17
2.5.1 臨床檢查 17
2.5.2 治療各階段之疼痛程度 18
2.5.3 治療各階段之焦慮程度 18
2.5.4 治療各階段之疼痛緩解程度 19
2.5.5 情緒與認知因素 19
2.5.5.1牙科焦慮評估 19
2.5.5.2 疼痛恐懼 20
2.5.5.3 疼痛災難化評估 20
2.5.6 自訂問卷：牙科治療疼痛經驗量表（DPEQ） 21
2.5.6.1自訂問卷之製定流程 22
2.5.6.2 自訂問卷之效度與信度評估 23
2.6統計分析 23
2.6.1 DPEQ信度測試 23
2.6.1.1內部一致性：Cronbach's alpha 23
2.6.1.2重測信度：級內相關係數（Intraclass correlation coefficient） 24
2.6.1.3病患受試者組與健康受試者之組間差異分析 24
2.6.2驗證研究假設之統計檢定 24
2.6.2.1描述性統計與常態性檢定（Normality test） 24
2.6.2.2曼－惠特尼檢定（Mann-Whitney U test） 25
2.6.2.3克魯斯寇－瓦立斯檢定（Kruskal Wallis U test） 25
2.6.2.4 魏克遜符號等級檢定（Wilcoxon test） 25
2.6.2.5 史皮爾曼相關係數（Spearman’s rank correlation coefficient） 26
第三章 研究結果 27
3.1牙科治療疼痛經驗量表（DPEQ）之信度 27
3.1.1 健康受試者描述統計分析 27
3.1.2 內部一致性信度 27
3.1.3 重測信度 27
3.2 臨床受試者描述統計分析 28
3.2.1 病患之臨床特徵 28
3.2.2臨床病患組與健康受試者組之組間差異分析 28
3.2.3臨床病患組之治療後後疼痛程度與不同臨床情況之差異分析 29
3.2.4臨床研究結果與常態性檢定 29
3.3子目標一：探討不可逆牙髓炎不同治療階段的變化 31
3.3.1 假設1-1：「治療後疼痛程度」顯著地低於「治療前疼痛程度」 31
3.3.2假設1-2：「治療後焦慮度」顯著地低於「治療前焦慮程度」 31
3.3.3假設1-3：「預期治療後疼痛程度」顯著地高於「治療後疼痛程度」 31
3.3.4假設1-4：「預期治療後疼痛緩解程度」與「治療後疼痛緩解程度」存在顯著的差異 31
3.3.5假設1-5：「回憶治療後疼痛程度」顯著地高於「治療後疼痛程度」 32
3.4子目標二：探討過去接受牙科治療的經驗與本次治療疼痛經驗的關聯性 32
3.4.1假設2-1：「過去疼痛經驗」與「治療前疼痛程度」呈顯著的正相關 32
3.4.2假設2-2：「過去焦慮經驗」與「治療前焦慮程度」呈顯著的正相關 32
3.4.3假設2-3：「過去疼痛經驗」與「預期治療後疼痛緩解程度」呈顯著的負相關 33
3.5子目標三：探討情緒與認知因素與治療疼痛經驗的關聯性 33
3.5.1疼痛恐懼 33
3.5.1.1假設3-1：「疼痛恐懼」與「預期治療後疼痛程度」呈顯著的正相關 33
3.5.1.2假設3-2：「疼痛恐懼」與「治療後疼痛程度」在呈顯著的正相關 33
3.5.1.3假設3-3：「疼痛恐懼」與「預期治療後疼痛緩解程度」呈顯著的正相關 33
3.5.1.4假設3-4：「疼痛恐懼」與「治療後疼痛緩解程度」呈顯著的正相關 34
3.5.2疼痛災難化 34
3.5.2.1假設3-1：「疼痛災難化」與「預期治療後疼痛程度」呈顯著的正相關 34
3.5.2.2假設3-2：「疼痛災難化」與「治療後疼痛程度」在呈顯著的正相關 34
3.5.2.3假設3-3：「疼痛災難化」與「預期治療後疼痛緩解程度」呈顯著的正相關 34
3.5.2.4假設3-4：「疼痛災難化」與「治療後疼痛緩解程度」呈顯著的正相關 35
3.5.3牙科焦慮 35
3.5.3.1假設3-1：「牙科焦慮」與「預期治療後疼痛程度」呈顯著的正相關 35
3.5.3.2假設3-2：「牙科焦慮」與「治療後疼痛程度」在呈顯著的正相關 35
3.5.3.3假設3-3：「牙科焦慮」與「預期治療後疼痛緩解程度」呈顯著的正相關 36
3.5.3.4假設3-4：「牙科焦慮」與「治療後疼痛緩解程度」呈顯著的正相關 36
3.6 疼痛緩解與疼痛改變量之關連性 36
第四章 討論 37
4.1 主要研究結果 37
4.2 研究結果與過去文獻之連結 37
4.2.1 不同臨床情況與治療後疼痛程度 37
4.2.2 子目標一：探討不可逆牙髓炎不同治療階段的變化 39
4.2.3 子目標二：探討過去接受牙科治療的經驗與本次治療疼痛經驗的關聯性 41
4.2.4 子目標三：探討情緒與認知因素與治療疼痛經驗的關聯性 42
4.2.5 本研究相較過去研究在方法學上的改進 45
4.3 本研究之侷限處與未來改進方法 46
4.3.1 受試者代表性之侷限 46
4.3.2 研究工具之侷限 46
4.3.3 統計分析之侷限 47
4.4 臨床意義 47
4.5 結論 48
參考文獻 50


圖目錄
圖一：文獻篩選流程圖 56
圖二：本研究之各變項的測量時間 57
圖三：研究收案流程 58
圖四：研究收案時間表 59
圖五：DPEQ疼痛經驗分數之Bland-Altman Plot 60
圖六：DPEQ恐懼經驗分數之Bland-Altman Plot 61
圖七：不同臨床情況之治療後疼痛程度的差異分析 62
圖八：比較治療各階段之疼痛程度，焦慮程度與疼痛緩解程度 63
圖九：過去接受牙科治療的經驗與本次治療疼痛經驗的關聯性 64
圖十：疼痛以及疼痛緩解程度與疼痛恐懼的關聯性 65
圖十一：疼痛以及疼痛緩解程度與疼痛災難化的關聯性 66
圖十二：疼痛以及疼痛緩解程度與牙科焦慮的關聯性 67
圖十三：治療後疼痛解程度與治療前後疼痛程度的差異的關聯性 68


表目錄
表一：研究變項與定義 69
表一：研究變項與定義（續） 70
表二：搜尋詞彙與搜尋結果 71
表三：所分析之文獻的研究族群與臨床資訊 72
表四：整合後之文獻分析結果 73
表五：受試者納入排除標準 75
表六：臨床檢查記錄表 76
表七：FDPQ原始題項 77
表八：DPEQ題項 78
表九：健康受試患者基本資料 79
表十：DPEQ問卷的疼痛經驗、恐懼經驗之重測信度 80
表十一：臨床受試患者基本資料 81
表十二：受試患者臨床資料 82
表十三：各臨床觀察變項之描述統計結果 83
表十四：研究假設與結論 86



附件
附件一：同意臨床試驗證明書 89
附件二：同意臨床試驗書函 90
附件三：臨床檢查記錄表 96
附件四：情緒與認知因素問卷 97

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