- 期刊
漸進式肌肉放鬆技巧能否降低椎板切除術病人術後疼痛？
Can progressive muscle relaxation techniques reduce postoperative pain in laminectomy patients?
摘要
形成臨床提問：椎板切除術，是指將脊突基部延伸至上下小關節連接處切除，使椎管減壓的手術。手術中需破壞肌肉骨骼組織，而疼痛為手術後常發生的健康問題，這是一種感覺及情緒上不愉快的經驗，此經驗可能與現存或潛在的組織傷害有關。臨床常使用視覺模擬量表評估疼痛程度，多以藥物治療控制疼痛，常使用非類固醇類與鴉片類止痛藥，但副作用與藥物療效存在個體的差異大。經查閱文獻後發現漸進式肌肉放鬆技巧可改善術後疼痛，故引發探討其漸進式肌肉放鬆技巧能否降低椎板切除術病人術後疼痛。文獻搜尋的方法與分析：本文依據實證五A之前三步驟（asking、acquire、appraisal），形成PICO問題。利用醫學主題詞（Medical Subject Heading, MeSH）、同義詞設定中英文關鍵字：椎板切除術（Laminectomy）或椎間盤突出（Intervertebral Disc Displacement）、肌肉放鬆治療（Muscle relaxation techniques）或肌肉放鬆技巧（Muscle relaxation therapy）、術後疼痛（Postoperative pain）。搜尋2016-2021年的資料庫，包括Cochrane、PubMed、CINAHL，限定系統性文獻回顧（Systematic Review, SR）或隨機對照試驗（Randomized Controlled Trial, RCT），最後納入1篇隨機對照試驗文獻進行評讀。文獻品質評讀：文獻評讀以2020年的Critical Appraisal Skills Programme（CASP）randomised controlled trial checklist為評讀工具，並採用牛津大學實證醫學中心建議證據等級評定，證據等級為Level II。本篇文獻是比較Benson放鬆和漸進式肌肉放鬆技巧對於改善椎板切除術後病人疼痛之成效，結果顯示漸進式肌肉放鬆技巧是一種非侵入性，且操作方便的放鬆療法，病人可透過影片學習，每次操作時間約10-20分鐘，依照全身肌肉群順序，感受肌肉群緊張後再放鬆並調整呼吸，學習以不同方法達到放鬆。結論與建議：綜合文獻顯示，漸進式肌肉放鬆技巧確實可以改善椎板切除術病人術後疼痛，建議可於臨床上提供非藥物措施，輔助減輕病人術後疼痛不適感，進而提升臨床護理品質。
並列摘要
Ask an answerable question (PICO): Laminectomy is an operation to decompress the spinal canal by extending the base of the spinal process to the junction of the upper and lower facet joints. During surgery, it is necessary to damage the musculoskeletal tissue, and pain is a common health problem that occurs after surgery. This is an unpleasant experience both physically and emotionally, and this experience may be related to existing or potential tissue damage. In clinical practice, assess pain using a visual analog scale, drug therapy is often used to control pain, and non-steroidal and opioid analgesics are often used, but there are individual differences in side effects and drug efficacy. After reviewing the literature, it was found that progressive muscle relaxation techniques can improve postoperative pain, so it was initiated to explore whether its progressive muscle relaxation techniques could reduce postoperative pain in patients with laminectomy. The Method and analysis of Literature Review: This paper forms the PICO problem based on the first three steps (asking, acquire, and appraisal) of 5A. Using medical subject headings (MeSH) terms and synonyms to set Chinese and English keywords: laminectomy or intervertebral disc displacement, muscle relaxation techniques or muscle relaxation therapy, postoperative pain. Searching databases from 2016 to 2021, including Cochrane, PubMed, CINAHL, limited systematic review (SR) or randomized controlled trial (RCT), and finally included 1 RCT for appraisal. Literature Quality Review: The 2020 Critical Appraisal Skills Programme (CASP) checklist was the tool for randomized controlled trial, the level of evidence was level II, the level of evidence by the center of Oxford University for Evidence-Based Medicine. This literature compared the effectiveness of Benson relaxation and progressive muscle relaxation techniques in improving postoperative pain among patients undergoing laminectomy. The results showed that progressive muscle relaxation was a non-invasive and easy-to-operate relaxation therapy for patients learned through videos. The operation time was about 10-20 minutes each time, and patients feel the tension in their muscle groups and then relaxed and adjusted their breathing according to the order of their entire muscle groups, learning to achieve relaxation through different methods. Conclusions and Recommendations: Comprehensive literature showed that progressive muscle relaxation can indeed improve postoperative pain in patients with laminectomy. It was suggested that non-drug measures could be provided in clinical practice to assist patients in reducing postoperative pain and discomfort, thereby improving the quality of clinical care.