臺灣博碩士論文加值系統

摘 要
醫療觀念由治療轉向預防，產科的發展趨勢轉而更加注重早產的預防與照護。安胎的這段過程中會帶來孕婦身心無比的煎熬，因而產生焦慮反應，造成心跳加快、血壓增高及呼吸加速等生理症狀，早產徵象對安胎孕婦是很大的威脅與焦慮來源，而子宮收縮是明顯的徵象，也是判斷進展最明顯的指標，所以孕婦在接受無加壓監測檢查會產生焦慮，如何適當的協助減輕焦慮，是護理要項之一，亦是醫療上很重要的任務。近年來音樂治療運用在各種減輕焦慮的效果在國內外頗受肯定；在國內目前幾乎沒有此方面相關研究應用於安胎之孕婦；因此本研究旨在探討音樂治療對安胎孕婦在接受無加壓監測檢查期間焦慮及生理反應的成效。
本研究是以北部某醫學中心之產科病房的安胎孕婦為對象，採用交叉配對（Cross-over design）之準實驗性研究法，實驗進行之次序分派以區段式隨機分派（Block randomization）方式進行，收案期間自民國90年1月1日至90年5月15日，共選取60位，每序組各取30位符合條件的安胎孕婦進行研究，每位安胎孕婦都是實驗組亦為自己的控制組。
研究工具包括音樂治療、研究量表及生理測量儀器三大部份。研究所得的資料，以SPSS10.0/Win98和SAS6.12/Win98套裝軟體進行次數分佈、百分比、平均值、標準差、卡方檢定、t檢定及廣義估計方程式（Generalized Estimating Equation; GEE）之線性模型等統計方法分析。
研究結果發現：一、未接受音樂治療時，兩組安胎孕婦在執行無加壓監測前，在基本人口學屬性、焦慮及生理反應均無顯著差異，同質性相當高。二、未接受音樂治療時，兩組安胎孕婦焦慮程度均屬中度焦慮，受妊娠週數與注意聽音樂比率之個人基本屬性的影響。三、音樂治療時焦慮程度與生理反應的改變量呈現正相關；即焦慮程度改變量越大其心跳、呼吸、收縮壓、舒張壓及平均血壓改變量亦越大。四、在給予音樂治療後，安胎孕婦在執行無加壓監測時焦慮程度明顯下降，兩組皆以「我覺得舒暢」、「我覺得愉快」及「我覺得輕鬆自在」得分改變量最多。五、音樂治療對生理反應的成效方面，在經過音樂治療後，心跳次數、呼吸次數、收縮壓、舒張壓及平均血壓皆有明顯降低。故本研究結果發現音樂治療對安胎孕婦在接受無加壓監測檢查期間焦慮程度減輕及生理反應降低皆有明顯改善之成效，值得在護理臨床上廣為推廣與應用。

ABSTRACT
With medical concept turned from simply providing treatment toward prevention, the development of obstetrics clinical has emphasized more on the prevention of and the assistance to preterm birth. Pregnant women in tocolysis go through a difficult process to secure the well being of both the mother and the baby. The process heightens anxiety and worsens certain anxiety-related physiological signs, such as of heart beat, blood pressure, and respiratory rate. Furthermore, symptom of preterm delivery presents as another threat and an anxiety source to pregnant women. One of typical symptoms is uterine contraction, which is a very useful indicator in determining progress.
Knowing the fact that pregnant women are existed with anxiety, it makes providing medical helps and assistance during the non-stress test in order to lower anxiety an important issue to nursing staff in the obstetric department. In recent years, music therapy has been applied to patients in various fields with encouraging results. However, no research in Taiwan was conducted on applying music therapy to preterm labor women in reducing anxiety. Hence, it motivated this research to study the effects on anxiety and physiology by giving music therapy during non-stress test to preterm labor women.
The targeted of this study was on preterm labor women which taken in a medical center of Taipei and the design of the study was based on the principle of cross-over design and block randomization. From January 1 to May 15 of 2001, sixty qualified subjects were recruited. Subjects were divided into two groups (experimental group and control group). Each subject was in both the experimental group and the control group.
Medical instruments and therapy techniques utilized in the study ranged from music therapy, various research scales, to physiology measuring devices. Data was processed and analyzed with SPSS 10.0/Win98 and SAS 6.12/Win98 for statistic information, which included Frequency Distribution, Percentile, Means, Standard Deviation, chi-square Test, t Test, and GEE.
Major findings of the study included: 1. with no music therapy prior to non-stress test, demography information, anxiety response, and physiology response shown no obvious difference between the two groups. 2. In term of level of anxiety, both groups were categorized as medium level and were influenced by subject’s weeks into gestation and subject’s concentration during music therapy. 3. After evaluating the results of the music therapy, it shown that change of anxiety index correlates positively to the change of physical indicators, which are heart beat, respiratory rate, systolic and diastolic blood pressure, and mean arterial pressure. 4. It shown anxiety condition is improved in both groups by music therapy that certain phases increased while performing non-stress tests. The appearing of phases as “I feel pleasant”, “I feel happy”, and “I feel easy” were increased in large proportion. 5. It shown, with music therapy, the physiological signs are improved. The readings of heart beat, respiratory rate, systolic and diastolic blood pressure, and mean arterial pressure were significantly lower.
In conclusion, based on the findings of this research it proved that music therapy is an effective method in lowering anxiety and improving anxiety-related physiological conditions to women in tocolysis during the performance of non-stress test. With the publication of this research, this could become a reference material of music therapy to obstetrical department’s nursing staffs who are currently taking care of women in tocolysis.

第壹章 緒 論 ……………………………………………………………… 1
第一節 研究動機及重要性…………………………………………… 2
第二節 研究目的……………………………………………………… 5
第三節 研究問題……………………………………………………… 6
第貳章 文 獻 查 證
第一節 具早產徵象安胎孕婦身心影響與護理需求………………… 7
第二節 焦慮概念……………………………………………………… 9
第三節 安胎孕婦與焦慮相關研究……………………………………14
第四節 音樂治療理論背景……………………………………………26
第五節 音樂治療相關研究……………………………………………32
第參章 研 究 架 構
第一節 研究概念架構…………………………………………………36
第二節 研究假設………………………………………………………37
第三節 名詞界定………………………………………………………37
第肆章 研究方法與過程
第一節 研究設計………………………………………………………39
第二節 研究對象及場所………………………………………………41
第三節 研究工具及信度與效度………………………………………42
第四節 研究步驟………………………………………………………45
第五節 資料統計與分析………………………………………………48
第六節 研究倫理考量…………………………………………………50
第伍章 研 究 結 果
第一節 研究對象人口學屬性…………………………………………51
第二節 研究對象面臨無加壓監測前焦慮程度及生理反應…………60
第三節 音樂治療後焦慮及生理反應改變量比較……………………65
第四節 研究對象人口學屬性與焦慮及生理反應之關係……………79
第五節 在接受無加壓監測檢查時焦慮與生理反應改變之相關分析88
第六節 音樂治療對安胎孕婦減輕焦慮及生理反應成效探討………91
第陸章 討 論
第一節 安胎孕婦於執行無加壓監測之焦慮程度及生理反應情形 104
第二節 研究對象人口學屬性與焦慮程度及生理反應之關係 ……105
第三節 研究對象焦慮程度及生理反應變項間之相關性 …………106
第四節 音樂治療減輕焦慮程度及生理反應之成效 ………………108
第柒章 結 論 與 建 議
第一節 結 論…………………………………………………………112
第二節 護理學上的應用 ……………………………………………114
第三節 研究限制及對未來研究的建議 ……………………………116

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