臺灣博碩士論文加值系統

目的：探討經皮穴位神經電刺激介入，對於改善大腸激躁症病人排便症狀及生活品質之成效。

背景：大腸激躁症為腸胃科門診病人就醫常見原因之一，因大腸激躁症屬於慢性且反覆發作
之疾病，若經治療後其症狀持續或改善幅度偏低時，將會影響患者在工作、學習及社交上等表現，嚴重時會影響患者日常生活並降低生活品質。研究指出針刺療法對於大腸激躁症患者有其療效，但少有研究針對大腸激躁症探討經皮穴位神經電刺激的成效。

方法：本研究採實驗性研究設計，以量性及質性資料瞭解經皮穴位神經電刺激介入的成效。本研究於新北市一家區域教學醫院之肝膽胃腸科門診進行收案，採方便取樣（convenience sampling）方式選取經醫師確診為大腸激躁症之患者後，並在病人完成前測問卷後，採隨機分派方式將病人分配進入介入組及控制組。介入組接受為期4週，每週3次，每次15分鐘的經皮穴位電神經刺激；控制組接受常規照護。收案30位大腸激躁症患者，兩組病人皆完成共四次的問卷填答，測量時間點分別為：前測、前測後第二週、前測後第四週及前測後第八週。結果變項包含生活品質及症狀嚴重度。此外介入組於前測後第八週進行結構式質性訪談及滿意度問卷填寫，以瞭解病人對介入的感受。量性資料採用SPSS 22.0版本進行資料分析，並以描述性統計及推論性統計，其如：百分比、平均值、標準差、最小值、最大值、獨立樣本t檢定（Independent sample t test）、卡方檢定及廣義估計式（Generalized estimating equations, GEE）進行統計分析。質性訪談資料以內容分析法進行分析。

研究結果：在IBS-SSS症狀嚴重分數部份，研究結果顯示經皮穴位神經電刺激介入組於前測後第二週相較於控制組減少10分；在前測後第四週相較於控制組減少1.33分，但在前測後第八週相較於控制組增加3.33分，但兩組之間在各時間點均未達統計顯著差異。在IBS-QOL生活品質分數方面，研究結果顯示經皮穴位神經電刺激介入組在前測後第二週相較於控制組減少6.27分，在前測後第四週相較於控制組減少3.73分，在前測後第八週相較於控制組減少3.67分，但兩組間在各時間點均未達統計顯著差異。而在WHO生活品質整體分數方面，研究結果顯示經皮穴位神經電刺激介入組在前測後第二週相較於控制組增加2.60分，在前測後第四週相較於控制組增加3.53分，在前測後第八週相較於控制組增加2.67分，但兩組間在各時間點均未達統計顯著差異。此外在各組隨時間變化部分，研究結果發現經皮穴位神經電刺激介入組之IBS-SSS量表得分，從前測至前測後八週降低24至34分；而控制組降低14至37.33分，雖未達統計顯著差異，但經皮穴位神經電刺激介入組分數降低多於控制組。此外生活品質部分，經皮穴位神經電刺激介入組在WHO量表整體得分從前測至前測後八週增加1.6分至2.86分；而控制組下降0.6至1.06分，研究均未達統計顯著差異。另一方面，在IBS-QOL量表得分發現經皮穴位神經電刺激介入組於前測至前測後八週減少2.93分至5.53分；而控制組在增加3.33分後下降1.60至1.80分，且經皮穴位神經電刺激介入組於前測後第四週及第八週達統計顯著差異，但控制組則未達統計顯著差異，經上述結果顯示經皮穴位神經電刺激介入組優於控制組。

結論：經皮穴位神經電刺激介入組及控制組的排便症狀隨時間延長皆會改善，但介入組優於控制組。相較於控制組，經皮穴位神經電刺激介入組有比較好的生活品質，不論是在WHO量表或IBS-QOL量表結果均相同，但只有IBS-QOL量表達統計上的顯著差異。建議未來研究可增加研究樣本數、延長介入時間及頻次，以確認經皮穴位神經電刺激之成效。

Purpose: To investigate the effects of transcutaneous electrical nerve stimulation on quality of life and bowel function in patients with irritable bowel syndrome.

Background: Irritable bowel syndrome is a common chronic and recurring disease treated in gastroenterology clinics, and can negatively affect patients in their careers, learning, and social behavior by lowering quality of life and impacting daily routines. Studies have shown that the effects of acupuncture-like treatments are beneficial, however few studies have investigated the effects of transcutaneous electrical nerve stimulation for treating irritable bowel syndrome.
Method: This experiment was designed to test the efficacy of transcutaneous electrical nerve stimulation. Participants were convenience-sampled after being diagnosed with irritable bowel syndrome by their doctor. After completing questionnaires, the patients were grouped randomly the into intervention or control group, for a total of 15 patients in each group. The intervention group received three stimulation treatments of 15 min duration per week for four weeks, while the control group received routine care. The patients completed four questionnaires on the patient’s quality of life and the severity of the syndrome that were collected during the 2nd, 4th, and 8th weeks after the experiment started. The intervention group also received a questionnaire regarding their satisfaction with the treatment. Questionnaire responses were analyzed using inferential statistics including average, standard deviation, minimum value, maximum value, independent sample t- tests , chi-squared test and generalized estimating equations.

Results: On the IBS-SSS scale, the intervention group decreased by 10 points in the 2nd week. The control group decreased by 10 points in the 4th week and increased by 3.53 points in the 8th week. On the IBS-QOL scale, the intervention group fell by 6.26 points compared to control. In the 4th and 8th weeks, the control group declined by 3.77 and 3.66 points respectively. On the WHO scale, in the 2nd, 4th, and 8th weeks, the control group rose by 2.6, 3.53, and 2.66 points, respectively. None of these differences were statistically significant.
In addition, the scores changed in each group at different times. The scores of IBS-SSS declined by 24–34 points around the 8th week. The score from the control group decreased by 14–37.33 points. On the WHO scale, scores rose from 1.6 to 2.86 around the 8th week in the intervention group, but fell from 0.6 to 1.06 in control. On the IBS-QOL scale, the score of the intervention group fell from 2.93 to 5.53, while that of the control group increased by 3.33 points and then declined by 1.6–1.8 points. The intervention group thus shows a clear progression in contrast to control.

Conclusion: The transcutaneous electrical nerve stimulation group and the control group both showed improvement in bowel symptoms over time, but the intervention group performed better than the control group, reporting better quality of life as indicated by the IBS-QOL scale. It is recommended that future research should use larger sample sizes, longer intervention duration, and higher treatment frequency to confirm the effectiveness of this treatment approach.

目錄
中文摘要 i
ABSTRACT iii
第一章 緒論 1
第一節 研究背景和動機及重要性 1
第二節 研究目的 3
第三節 研究問題 3
第四節 名詞解釋 4
第二章 文獻探討 7
第一節 大腸激躁症之介紹 7
第二節 中醫對大腸激躁症之概述 14
第三節 大腸激躁症患者生活品質之介紹 19
第四節 經皮穴位神經電刺激對大腸激躁症患者之成效 21
第三章 研究方法 25
第一節 研究架構、研究假說 25
第二節 研究設計 27
第三節 研究場所及對象 28
第四節 樣本數估算 29
第五節 經穴位電神經刺激療法之介紹 30
第六節 常規照護之介紹 31
第七節 研究工具 32
第八節 資料收集過程 37
第九節 量表信效度檢測 39
第十節 研究倫理考量 41
第十一節 資料處理及分析 42
第四章 研究結果 44
第一節 研究對象基本屬性之分析與同質性檢定 44
第二節 前測時排便症狀及生活品質之得分分布與同質性檢定 58
第三節 兩組於各時間點排便症狀及生活品質之得分分布 60
第四節 經皮穴位神經電刺激介入對於改善排便症狀之成效 63
第五節 經皮穴位神經電刺激介入對於提升生活品質之成效 65
第六節 介入組及控制組排便症狀隨時間之變化 67
第七節介入組及控制組生活品質隨時間之變化 69
第五章 討論 82
第一節 經皮穴位神經電刺激介入對於改善病人排便症狀之成效 82
第二節 經皮穴位神經電刺激介入對於改善病人生活品質之成效 84
第三節 介入組及控制組排便症狀隨時間之變化 85
第四節 介入組及控制組生活品質隨時間之變化 86
第六章 結論、研究限制與建議 87
第一節 結論 87
第二節 研究限制 88
第三節 研究建議 90
參考資料 92
附錄 108
附錄一 基本屬性研究問卷 108
附錄二、台灣簡明版世界衛生組織生活品質問卷(WHOQOL-BREF,Taiwan version) 112
附錄三、IBS Severity Score（IBS症狀嚴重程度量表；IBS-SSS） 115
附錄四、Irritable Bowel Syndrome Quality of Life (IBS-QOL) 117
附錄五、Bristol糞便性質量表 119
附錄六、專家效度名單 120
附錄七、量表專家意見及修訂結果 121

表目錄
表2-1 大腸激躁症相關針刺研究 24
表3-1 研究假設之推論性統計方法 43
表4-1 介入組與控制組於前測時基本屬性變項之同質性檢定 52
表4-2 介入組與控制組於前測時疾病史影響變項之同質性檢定 56
表4-3 介入組與控制組於前測時及不同評估時間點COVID19疫情影響變項之同質性檢定 57
表4-4 介入組與控制組於前測時結果變項之同質性檢定 59
表4-5 兩組於各時間點監測WHO量表、IBS-SSS量表及IBS-QOL量表得分情況 62
表4-6 以廣義估計方程式分析經皮穴位神經電刺激介入於改善排便症狀之成效（N = 30） 64
表4-7 以廣義估計方程式分析經皮穴位神經電刺激介入於提升生活品質之成效（N = 30） 66
表4-8 以廣義估計方程式進行統計分析介入組及控制組分別於第二週、第四週、第八週排便症狀之
變化 68
表4-9 以廣義估計方程式進行統計分析介入組及控制組分別於第二週、第四週、第八週生活品質之
變化 71
表4-10介入組對於經皮穴位電刺激介入的回饋與感受 81

圖目錄
圖1-1 多頻道多模組電刺激器 6
圖2-1 足三里穴（正面、側面） 18
圖2-2 天樞穴 圖2-3三陰交穴 18
圖3-1 研究架構 25
圖3-2 研究設計表 27
圖3-3 資料收集過程 38
圖4-1 CONSORT流程圖 51

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