比較兩種臥床加壓時間對經皮穿肝術後病患舒適程度及出血合併症之影響

Compare the Effects of Two Different Protocols of Bed Rest and Sandbag Compression on Comfort Level and Bleeding Complications of Patients Who Underwent Percutaneous Liver Paracentesis

溫明寰(Ming-Huan Wen)

指導教授 ： 蔡仁貞

臺北醫學大學/護理學院/護理學研究所/碩士(2003年)

摘要

根據衛生署統計89年度台灣地區肝病死亡人數達1萬人以上，在肝病的檢查與治療中，侵入性的經皮肝臟穿刺術為常見的方式之一，其又分為肝臟切片與酒精注射治療；有鑑於臨床護理實務及國內外文獻中，對肝臟切片檢查及酒精（或醋酸）注射治療後病患臥床及砂袋加壓穿刺部位的時間由2小時到24小時皆有，整體而言缺乏實證依據；而病患於臥床期間常因穿刺導致疼痛，且因臥床加壓期間活動受限的時間過長造成不適。在考量病患安全、舒適狀況下，故研究之目的係探討不同臥床及砂袋加壓時間對經皮穿肝術後病患舒適程度及出血合併症之影響。 本研究於台北市北區某醫學中心之腸胃科病房為主要收案場所，針對診斷為肝病且進行肝臟切片檢查或行酒精（或醋酸）注射治療之住院病患進行資料收集，採隨機方式選取肝臟切片2小時組及6小時組及酒精（或醋酸）注射2小時組及6小時組，共有133位個案完成此研究。資料分析採次數分佈、百分比、平均值、標準差、t檢定、卡方檢定、repeated-measures ANOVA、Spearman及Pearson相關性分析，分別討論兩種臥床加壓時間對病患之舒適程度及出血合併症之影響。 研究結果發現：（一）經皮穿肝病患臥床平躺2小時組於術後第6小時之各項不舒適因素項目較於6小時組少，GCQ舒適得分較6小時組高，VAS自覺舒適程度亦較6小時組高。（二）經皮穿肝術後病患臥床平躺2小時組與6小時組在術後發生出血合併症無差異。（三）人口學特質於兩組病患於舒適程度呈現部份相關，但與出血合併症無關。期本研究結果能提供未來臨床護理技術改進的依據，藉以提供有效之護理措施及提高臨床護理活動的品質。

關鍵字

肝臟切片 ； 酒精 ； 或醋酸 ； 注射 ； 舒適程度 ； 出血合併症

並列摘要

According to the statistics from the Ministry of Hygiene, more than 10 thousand people in Taiwan died of liver diseases in 2000. Liver biopsy and percutaneous ethanol (or acetic acid) injection are the treatment procedures most commonly used to diagnosis the degree of liver damage and treat patients with hepatocellular carcinoma. Following the treatment procedures, patients were recommended to rest in bed for at least two hours. The current recommendation for bed rest time varies from 2 to 24 hours following the percutaneous liver paracentesis procedure. During the resting period, patients often feel pain and discomfort resulting from the needle puncture , prolonged confinement and pressure of bed rest. Since there is lack of scientific literature proving the ideal bed rest durations after the percutaneous liver paracentesis. This research was conducted to investigate the effects of the different time periods of bed rest and sandbag compression on patients’ comfort level and bleeding complications after the procedures. This research took place in a medical center located in the northern area of Taipei, Taiwan. The qualified patients were (1) diagnosed and hospitalized with liver diseases and (2) had liver biopsy or percutaneous ethanol (or acetic acid) injection. The qualified patients were randomly divided into two groups according to their bed rest duration. There were a total of four groups: (1) liver biopsy 2-hour bed rest group, (2) liver biopsy 6-hour bed rest group, (3) percutaneous ethanol (or acetic acid) injection 2-hour bed rest group, and (4) percutaneous ethanol (or acetic acid) injection 6-hour bed rest group. A total of 133 patients participated in this study. The effects of different bed rest time on comfort level and bleeding complications were discussed. The data were summarized and statistical by mean±standard deviation, independent-t test, Chi-square test, repeated- measures ANOVA, Spearman and Pearson correlation were used as statistical analyses as appropriate. This research provides a scientific base for clinical nursing practice. The conclusions of the research are the following: (1) At the sixth hour post procedure, the patient’s discomfort factors of the 2-hour group are less than the 6-hour group. Both the GCQ score and the VAS comfort level of the 2-hour group are higher than that of the 6-hour group. (2) There is no difference in the incidence of bleeding complications between 2-hour and 6-hour bed rest group. (3) Demographic data are partly related to the comfort level but no relationship to bleeding complications.

並列關鍵字

liver biopsy ； percutaneous ethanol (or acetic acid) injection ； comfort level ； bleeding complications

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