肌肉鬆弛訓練技巧對心臟手術後病患疲憊程度改善成效之探討

The Effects of Muscle Relaxation in Improving Fatigue Reduction among Cardiac Surgery Patients

林璟淑(Juin-Shu Lin) ； 廖彥琦(Yen-Chi Liao)

《慈濟護理雜誌》 2卷4期 (2003/12) Pp. 46-54

https://doi.org/10.6974/TCNJb.200312.0046

摘要

本研究目的為探討肌肉鬆弛訓練對心臟手術後病患疲憊程度與感受度之影響。採類實驗性研究法，研究對象為某醫學中心心臟外科病房第一次接受冠狀動脈繞道手術（Coronary Aretery Bypass Graft,CABG），並符合臨床路徑治療計劃者共60名。研究分為實驗組及對照組各30名，實驗組於術前先教導肌肉鬆弛訓練，並於術後第四至十天每天上、下午各一次20分鐘之肌肉鬆弛訓練活動；對照組採一般常規護理。研究工具為「CABG病患疲憊評估量表」，資料收集時間為術前及術後八個時間點。研究資料以百分比、平均值、標準差、卡方檢定、paired t檢定及重覆測量變異數分析進行分析。結果顯示：冠狀動脈心臟病患呈現中度疲憊情況。兩組個案疲憊程度高峰均在手術後第四天。疲憊程度隨著術後恢復天數增加而降低，實驗組於手術後第四天到第五天之間疲憊下降程度有統計上之差異（t=4.09,p﹤.05），其後疲憊下降程度雖無統計上之差異，但疲憊評分均為中低程度；對照組在手術後第四天開始每日疲憊下降程度均有統計上之差異（p﹤.00），但每日疲憊程度較實驗組高。疲憊表徵以自覺生病、無法維持挺直姿勢、動作和反應變的較慢、覺得站不穩、全身疲憊與肩膀僵硬等出現次數最多。本研究提供護理人員對肌肉鬆弛訓練之成效，可做為日後照護心臟病患疲憊改善服務品質提升之參考。

關鍵字

心臟手術病患 ； 疲憊 ； 肌肉鬆弛訓練

並列摘要

The purpose of this study was to evaluate the effect of muscle relaxation training in improving the sensation of fatigue among patients who underwent coronary artery bypass grafting surgery. 60 patients were scheduled to undergo coronary artery bypass grafting surgery, selected and divided into experimental group (n=30) and control group (n=30). For the patients in the experimental group, they underwent muscle relaxation training pre-operatively and 4 to 10 days postoperatively. Each session of training was twenty minutes per day. On the other hand, patients in the control group did not receive muscle relaxation training other than regular nursing care. All patients required to record their perception of fatigue on an assessment scale. Result: Patients who underwent CABG showed moderate degree of fatigue in general. The sensation of fatigue was maximal at Day 4 postoperatively in both groups. The degree of fatigue perceived by participants decreased gradually after Day 4 postoperatively. The experimental group demonstrated statistically significant reduction of perception of fatigue from Day 4 to Day 5 (t=4.09;p﹤.05). Although the reduction in perception of fatigue after Day 5 in the experimental group was clinically insignificant, the overall fatigue level was at low-to-moderate level. From Day 4 onwards postoperatively, the control group showed statistically significant reduction in sensation of fatigue (p﹤.00). Overall speaking, the level of fatigue sensation was higher in the control group based on the assessment scale. Perception of fatigue by participants mostly manifested in the form of self awareness of illness, inability to maintain upright posture, slurred response and action, ataxia, general tiredness, stiffness of shoulder. The result of this study suggests strongly the importance of muscle relaxation training in accelerating the postoperative recovery of patients undergoing CABG. Therefore the nursing staff should take into serious consideration the provision of muscle relaxation training in their regular nursing care.

並列關鍵字

cardiac surgery patients ； fatigue ； muscle relaxation