改善全身麻醉術後病人噁心嘔吐之成效-以手腕式扣環按壓穴道為例

根據世界衛生組織( World Health Organization, WHO, 2004 )全球手術量統計，全世界每年約進行234,2百萬次手術，全身麻醉術後噁心、嘔吐發生率為10至30%，雖然術後噁心嘔吐不會直接造成生命威脅，卻是令人感到極為不舒服的經驗。傳統中醫介入西方醫學體系，在治療及效果是相輔相成的，本研究運用手腕式扣環按壓刺激病人內關穴，改善全身麻醉術後噁心和嘔吐症狀。本研究為開放式雙組後測的類實驗研究，採立意取樣，以臺灣中部區域醫院進行全身麻醉者為對象，徵得受試者同意後，共收案110位病人，分成對照組（n＝55）一般醫療照護組及實驗組（n＝55），並於術前24小時配戴手腕式扣環( sea-band )，於全身麻醉前期之術前評估24小時、麻醉誘導前30分鐘、術後1小時，分別按壓雙手腕內關穴共20分鐘，以中文版羅氏噁心、嘔吐及乾嘔量表（INVR）、噁心視覺類比量表（VAS）與比較改善後之主觀感受，並於術後2小時、6小時、24小時測量介入後成效。使用SPSS 25版統計軟體進行資料分析。本研究發現：兩組平均年齡介於37.36±8.34歲、以女性、身體質量指數介於24.27±2.21、ASA-PSⅡ、大學學歷、無抽菸史、無飲酒史、無動暈症、無全身麻醉經驗史、無術後PONV史、一般外科科別為多，以腹腔鏡膽囊切除術、手術時間滿1－2小時、麻醉時間滿2－3小時、麻醉後期無使用鴉片止痛劑為最。實驗組在術後噁心、乾嘔次數以術後6小時、24小時為多；噁心、乾嘔不適感以術後6小時、24小時多；噁心持續時間為術後6小時、24小時，皆比對照組有效改善術後噁心及乾嘔；嘔吐則不具顯著性；運用手腕式扣環按壓於穴位確實可有效地改善術後6、24小時的噁心和嘔吐發生率，年齡、身體質量指數、ASA-PS；麻醉全期狀態與手術持續時間、麻醉持續時間皆呈顯著正相關，具抽菸史、身體質量指數、科別、手術持續時間、麻醉持續時間、曾經有動暈症者則呈顯著預測因子。噁心視覺類比量表與改善後主觀感受於術後6小時、24小時實驗組皆優於對照組。因而證實手腕式扣環按壓內關穴降低病人術後噁心嘔吐得成效。依研究結果建議：手腕式扣環按壓內關穴確實可以降低病人術後噁心嘔吐，希望培養麻醉護理人員了解與熟悉中醫輔助療法，並將穴位按壓納入麻醉護理教育課程及繼續教育積分。期望優化麻醉全期護理之照護品質與實務應用穴位按摩之方法。

關鍵字

內關穴；全身麻醉；麻醉全期護理；術後噁心嘔吐

並列摘要

The number of global surgeries around 234.2 million every year in the world. (World Health Organization 2004), the rate of Nausea and vomiting hap-pened after general anesthesia is 10 to 30%, postoperative nausea and vomiting ( PONV ) not only directly life threatening, but also leading to poor and uncom-fortable experience for patient. Therefore, purpose of this study was to relief pa-tient’s PONV after general anesthesia, using sea-band to press on patient’s Neiguan acupuncture point during holistic operative period. This study’s patients were from the regional hospital in central Taiwan. Af-ter patient consent, this quasi - experimental research were from 110 patients were admitted and sampling into control group (n=55), and experimental group (n=55). Experimental group wore sea-band 24 hours before the operation start-ed, and pressed the Neiguan acupuncture point on both wrists for 20 minutes during holistic operation period. Apply the Rhodes Nausea, Vomiting, and Retching Scale (INVR) and Nausea Visual Analog Scale (VAS) to compares two group samples feelings after interventional effects. Researchers would document patient experiences at 2 hours, 6 hours, and 24 hours from operation times to post-operation. Data analysis were used by SPSS version 25 statistical software for descriptive and inferential statistics. The patients average age were 37.36±8.34 years old, female, body mass in-dex between 24.27±2.21, ASA-PS II, university graduated, no smoking history, no drinking history, no motion sickness, no general anesthesia experience, no history of PONV, patient with general surgery, laparoscopy Cholecystectomy, operation time during 1 to 2 hours, anesthesia time about 2 to 3 hours, and none used opiate analgesics at post-anesthesia were the majority of sample. In the ex-perimental group, the times of PONV and duration of nausea at post-operation 6 hours and 24 hours, and the patient subjective feeling of PONV, had significant different with control group, but the symptoms of vomiting were not. Patient’s age, body mass index, and ASA-PS; the overall anesthesia status had positive relation with the operation and anesthesia time for PONV. In stepwise regression analysis, smoking history, body mass index, different department, the time spent of operation and anesthesia, and previous motion sickness were significant pre-dictor. This study result had confirmed that using sea-band to press Neiguan acu-puncture point could effectively prevent PONV and relief patients suffering ex-perience. The study result could apply the acupuncture to clinical practice de-crease side effect of general anesthesia, and introduced to anesthesia nursing ed-ucation for improving quality of anesthesia.