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研究生:盧怡如
研究生(外文):Lu,Yi-Ju
論文名稱:引導圖像冥想法介入腹腔鏡膽囊切除術後患者之成效
論文名稱(外文):The Effectiveness of Guided Imagery Meditation in Patients after Laparoscopic Cholecystectomy Surgery
指導教授:李梅琛李梅琛引用關係
指導教授(外文):Lee, Mei-Chen
口試委員:李梅琛陳慶耀梁淑媛
口試委員(外文):Lee, Mei-ChenChen, Chin-YauLiang, Shu-Yuan
口試日期:2020-07-29
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:中文
論文頁數:148
中文關鍵詞:引導圖像冥想法腹腔鏡膽囊切除術膽結石術後疼痛焦慮睡眠品質疼痛控制
外文關鍵詞:Guided imagery meditationLaparoscopic cholecystectomyGallstonesPostoperative painAnxietySleep qualityPain control
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背景及目的:膽結石是一般外科病房最常見的消化道疾病,國人膽結石的發生率約5-10%,常因為腹部疼痛到醫院治療。目前膽結石大多以腹腔鏡膽囊切除手術治療為主,而手術後疼痛是外科病人最困擾的問題之一。然而,高達百分之九十的腹部手術後患者仍經歷中度至重度的疼痛,這不僅影響病患的身體恢復狀況,也會造成病人心理上的焦慮不安,提供良好的術後疼痛處置相當重要。因此,本研究目的為探討膽結石患者透過引導圖像冥想法的介入於腹腔鏡膽囊切除術後,改善病患術後疼痛、減少焦慮、促進睡眠品質及增加疼痛控制滿意度之成效。
研究方法:本研究採前、後測隨機控制試驗,採隨機、單盲、實驗性研究設計。於東北區教學醫院一般外科病房進行收案。研究問卷包含疼痛程度用數字等級量表(The 11-point Numeric Rating Scale, NRS-11) 及臉譜量表(The 11-face Faces Pain Scale, FPS-11)評估,焦慮程度則使用中文版貝克焦慮量表(The Chinese version of Beck Anxiety Inventory, BAI)、疼痛控制滿意度則使用視覺類比量表(Visual Analogue Scales, VAS)、睡眠品質則使用中文版匹茲堡睡眠品質量表(Chinese Pittsburgh Sleep Quality Index, CPSQI) 等變項進行評估。本研究樣本數以G-Power 3.1.2版之統計軟體計算至少共收集68位,採隨機分配方式進行分組,控制組(常規護理)及實驗組(引導圖像冥想法介入方案)各34位。兩組於前測後再進行介入性方案,分別於出院前(術後第二天)進行後測,本研究所得資料以統計軟體SPSS 22.0做統計分析方法,描述性統計做次數、分配、百分比、平均值、標準差、最大值和最小值。推論性統計分析以卡方 (Chi-square test) 檢定、獨立樣本t檢定(t-test)、共變數分析(Analysis of covariance, ANCOVA)檢定前、後測結果,以比較兩組在疼痛指數、焦慮程度、睡眠品質及疼痛控制滿意度的差異。
研究結果:本研究之研究對象為中壯年、肥胖、女性、國高中畢業居多、已婚、就業中、佛道教宗教信仰,過去病史以骨科手術為最多。以獨立樣本t檢定檢視兩組於人口學、疾病特徵、睡眠品質及焦慮指標的差異性,兩組皆無顯著差異( p > .05)。兩組前、後測以ANCOVA檢定,在方案介入後實驗組及控制組之組間CPSQI值差異比較,兩組總平均得分為5.11分(SD = 3.83),實驗組平均得分為2.67分(SD = 1.96),控制組平均得分為7.55分(SD = 3.81),達統計上顯著差異(F = 39.99, p < .001, Partial eta2 = 0.39);而實驗組CPSQI分數低於控制組。焦慮分數差異比較,兩組總平均得分為2.61分(SD = 5.78),實驗組平均得分為0.42分(SD = 0.97),控制組平均得分為4.79分(SD = 7.56),達統計上顯著差異(F = 8.04, p < .01, Partial eta2=0.11),實驗組焦慮分數低於控制組。以獨立樣本t檢定兩組於引導圖像冥想法方案介入後其疼痛程度、疼痛控制滿意度的差異性,疼痛程度量表中的平均疼痛程度次量表研究對象總平均為3.11分(SD = 1.75),其中控制組為4.00分(SD = 1.62)高於實驗組2.21分(SD = 1.39),達顯著差異(t = 1.94, p < .001)。另外,在疼痛控制滿意度的VAS研究族群總平均8.50分(SD = 1.54),其中實驗組為9.48分(SD = 0.87)高於控制組為7.52分(SD = 1.44)達顯著差異(t = 9.16, p < .001)。
結論:本研究結果證實運用引導圖像冥想法介入方案對於接受腹腔鏡膽囊切除手術術後患者,可有效緩解患者術後疼痛、降低焦慮、提升睡眠品質以及疼痛控制滿意度。因此,引導圖像冥想法為簡單不具侵入性之非藥物介入性措施,此研究結果可做為手術後減輕疼痛、焦慮程度,及增加睡眠品質以及疼痛控制滿意度之介入性措施。
臨床與實務應用:本研究證明引導圖像冥想法介入方案簡單、易學及易操作的優點,具實證學理基礎能緩解術後疼痛、減少焦慮、促進睡眠品質及提高手術後疼痛控制滿意度的結果,以實證引導圖像冥想法運用於臨床照護的效果。希望能提供具實證基礎的介入成效以改善腹腔鏡術後患者所衍生的相關問題,提升病人術後的生活品質。期許本論文結果能增加實證學術文獻,及提供醫護人員在術後照護和疼痛控制的學理依據。

Background and purpose: Gallstones are the most common digestive tract disease in a general surgical ward. The incidence of gallstones in Taiwan is about 5-10%, and most of the patients are often treated in hospital because of abdominal pain. At present, most gallstones are treated by means of a laparoscopic cholecystectomy, and post-operative pain is one of the most troublesome problems for surgical patients. Up to 90% of patients still experience moderate to severe pain after abdominal surgery, which not only affects their physical recovery, but it also causes psychological anxiety. Therefore, it is very important to provide good post-operative pain management. The purpose of this study to explore the effect of guided imagery meditation for improving post-operative pain, reducing anxiety, promoting sleep quality and increasing pain control satisfaction in patients with gallstones, after a laparoscopic cholecystectomy.
Research methods: This study consisted of a randomized pre- and post- measurement control trial, and a randomized, single-blind, experimental research design. The case study was conducted in the general surgical ward of teaching hospital in the north-east Taiwan. The study questionnaire included a digital scale of the pain levels (the 11-point Numeric Rating Scale, NRS-11) and a face pain scale (The 11-face Faces Pain Scale, FPS-11), while the anxiety levels were assessed using the Chinese version of Beck Anxiety Inventory (BAI), the pain control satisfaction was assessed using variables such as the Visual Analog Scale (VAS), and the sleep quality was measured by using the Chinese Pittsburgh Sleep Quality Index (CPSQI). A total sample number of 68 subjects was obtained by using the G-Power Version 3.1.2 statistical software, the randomized assignment method for grouping was used, and the control group (usual care) and experimental group (guide image meditation) consisted of 34 subjects each. Two groups were used for pre-test before the intervention program, and at discharge day (postoperative day 2) for the post-test. The data of the descriptive statistics indicated the number, distribution, percentage, average, standard difference, and maximum and minimum values were analyzed by using the statistical software SPSS 22.0. An inferential statistical analysis was used to compare the difference between the two groups with regard to the pain index, anxiety, sleep quality, and pain satisfaction control, both before and after the analysis of the chi-square test, the independent sample t-test, and the analysis of covariance (ANCOVA).
Research results: The research subjects of this study were middle-aged and obese females, most of whom had graduated from high school in Taiwan, were married, employed, and of the Buddhist or Taoist religious beliefs. Orthopedic surgery was the most common surgical history in their past. An independent sample t-test was used to examine the differences between the two groups with regard to their demographics, disease characteristics, sleep quality, and anxiety indicators. There were no significant differences between the two groups (p > .05). The two groups were tested by ANCOVA before and after the test. After the intervention program, the difference between the CPSQI values of the experimental group and the control group was compared. The total average score of the two groups was 5.11 (SD = 3.83), and the average score of the experimental group was 2.67 (SD = 1.96) There were statistically-significant differences in the scores (F = 39.99, p < .001, Partial eta2 = 0.39): the average score of the control group was 7.55 (SD = 3.81) points, while the CPSQI value of the experimental group was lower than that of the control group. A comparison was made of the different anxiety scores. The total average score of the two groups was 2.61 (SD = 5.78), and the average score of the experimental group was 0.42 (SD = 0.97). The statistically-significant difference was (F = 8.04, p < .01, Partial eta2 = 0.11), the average score of the control group was 4.79 (SD = 7.56), while the anxiety score of the experimental group was lower than that of the control group. An independent sample t-test was used to test the difference between the pain level and pain control satisfaction of the two groups, after the intervention of the guided imagery meditation program. The average pain level on the pain level scale was 3.11 points (SD = 1.75), of which the control group scored 4.00 (SD = 1.62) higher than the experimental group, which scored 2.21 (SD = 1.39), which were significantly different (t = 1.94, p < .001). In addition, the overall average of the VAS study population in pain control satisfaction was 8.50 (SD = 1.54), of which the experimental group was 9.48 (SD = 0.87) and the control group was 7.52 (SD = 1.44), which were significantly different (t = 9.16, p < .001).
Conclusion: The results of this study confirmed that the use of the guided imagery meditation intervention program for patients undergoing a laparoscopic cholecystectomy can relieve post-operative pain, reduce anxiety, improve sleep quality and pain control satisfaction. Therefore, guided imagery meditation is a simple and non-invasive non-pharmacological intervention. The results of this study can be used as an intervention to reduce pain and anxiety after surgery and to increase sleep quality and pain control satisfaction.
Clinical and practical applications: This study demonstrates the advantages of simple, easy-to-learn and easy-to-operate intervention programs for guided imagery meditation, which provides an evidence-basis for relieving post-operative pain, reducing anxiety, promoting sleep quality, and improving satisfaction with post-operative pain control. Evidence guided imagery meditation will, therefore, have an effect on clinical care. It is expected that the results will provide an evidence-based intervention for improving the related problems arising in patients after laparoscopic surgery and that it will improve the quality of life of patients after surgery. It is hoped that the results of this paper will improved evidence literature and provide medical personnel with an evidence basis for post-operative care and pain control.

摘 要 i
Abstract iv
目 次 viii
表 次 x
圖 次 xi
附錄次 xii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 5
第三節 研究問題 6
第四節 研究假設 7
第五節 名詞解釋 8
第二章 文獻查證 11
第一節 膽結石 11
第二節 手術後疼痛 16
第三節 引導圖像冥想法 19
第四節 疼痛對手術後患者的衝擊 40
第三章 研究方法 45
第一節 研究設計 45
第二節 收案地點 46
第三節 研究對象 47
第四節 研究工具 48
第五節 研究步驟 58
第六節 資料統計與分析 59
第七節 倫理考量 62
第四章 研究結果 63
第一節 研究對象人口學基本資料及疾病特徵之描述與比較 63
第二節 方案介入前測成效測量之描述與比較 67
第三節 方案介入後止痛藥與疼痛程度之描述與比較 70
第四節 方案介入前、後測量之成效 73
第五章 討論 76
第一節 人口學基本資料與疾病特徵之討論 76
第二節 方案介入前測成效測量之討論 80
第三節 方案介入後止痛藥使用與疼痛程度之討論 83
第四節 方案介入前、後測量之討論 85
第六章 研究結論、研究限制與建議 87
第一節 研究結論 87
第二節 研究限制 88
第三節 建議 90
參考文獻 92


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