探討咀嚼口香糖與穴位按壓對結直腸切除術後病人腸道功能恢復之成效

背景：腸阻塞是腹部手術後常見的問題，而手術後咀嚼口香糖及進行足三里穴位按壓皆有文獻提及可做為促進腸道功能之安全措施，但咀嚼口香糖之成效需進一步介入探討。研究目的：探討咀嚼口香糖與穴位按壓對結直腸切除術後病人腸道功能恢復之成效。材料與方法：為隨機對照試驗，研究對象為南部某區域醫院外科病房行結直腸切除術之結直腸癌成人，隨機分為咀嚼口香糖組、穴位按壓組及常規照護組，每組各30人。所有研究對象收集首次排氣時間、開始腸蠕動時間、腸蠕動次數、住院天數、術後合併症等資料。結果：共收案90位結直腸癌病人，研究結果顯示三組首次排氣時間（59.86±20.18小時vs. 62.18±18.89小時vs. 51.03±2.88小時，p＝ .05）、開始腸蠕動時間（p＝.46）、術後腸蠕動次數（p＞.05）皆無顯著差異；雖發現接受穴位按壓後最多個案在術後第一天早上即有腸蠕動，再者是咀嚼口香糖組，但此差異三組亦未達顯著。咀嚼口香糖與穴位按壓皆是耐受性良好、安全性高措施。結論：依據本研究發現，進行腹腔鏡手術之結直腸切除術病人可依目前臨床常規儘早下床活動來促進腸道功能恢復。本研究為初探性研究，建議未來需進行更大規模、嚴謹研究以繼續探究促進腸道恢復之介入措施。

關鍵字

咀嚼口香糖；穴位按壓；術後腸道功能恢復；結直腸切除術

並列摘要

Purpose: The aim of the study was to explore the effectiveness of chewing gum and acupressure in improving of postoperative gastrointestinal function after colorectal surgery. Methods: This is a randomized controlled trial that participants were recruited from a surgical ward in a regional hospital in southern Taiwan. Patients with colorectal cancer who had undergone colorectal surgery were randomly assigned to the chewing gum group, the acupressure group, and the standard care group. Each group consist of thirty patients. The outcome measures were the time to first flatus, time to first bowel movement, frequency of bowel sounds, length of hospital stay, and complications. Results: Ninety patients were included this study. The results showed that chewing gum or acupressure does not appear to improve postoperative gastrointestinal function over standard care after colorectal surgery. Most patients after acupressure were occurred the first bowel movement on the first postoperative morning followed by the chewing gum group but the difference also not reach significantly. Chewing gum or acupressure are tolerated well and safe method. Conclusions: Based on this finding, the postoperative gastrointestinal function after laparoscopic surgery for colorectal resection could be hastened by the routine care with early mobilization. This is the preliminary study, further studies with larger sample sizes and rigorous design are required to proceed explore the effect to improve of postoperative gastrointestinal function.

並列關鍵字

Chewing Gum ； Acupressure ； postoperative gastrointestinal function ； colorectal surgery

參考文獻

Chao, H. L., Miao, S. J., Liu, P. F., Lee, H. H., Chen, Y. M., Yao, C. T., & Chou, H. L. (2013). The beneficial effect of ST-36 (Zusanli) acupressure on postoperative gastrointestinal function in patients with colorectal cancer. Oncology Nursing Forum, 40(2), E61-68. doi:10.1188/13.onf.е61-е68

Chen, J., Song, G. Q., Yin, J., Koothan, T., & Chen, J. D. (2008). Electroacupuncture improves impaired gastric motility and slow waves induced by rectal distension in dogs. American Journal of Physiology. Gastrointestinal and Liver Physiology, 295(3), G614-620. doi:10.1152/ajpgi.90322.2008

de Leede, E. M., van Leersum, N. J., Kroon, H. M., van Weel, V., van der Sijp, J. R. M., & Bonsing, B. A. (2018). Multicentre randomized clinical trial of the effect of chewing gum after abdominal surgery. The British Journal of Surgery, 105(7), 820- 828. doi:10.1002/bjs.10828

Fitzgerald, J. E., & Ahmed, I. (2009). Systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery. World Journal of Surgery, 33(12), 2557-2566. doi:10.1007/s00268-009-0104-5

Ge, B., Zhao, H., Lin, R., Wang, J., Chen, Q., Liu, L., & Huang, Q. (2017). Influence of gum-chewing on postoperative bowel activity after laparoscopic surgery for gastric cancer: A randomized controlled trial. Medicine (Baltimore), 96(13), e6501. doi:10.1097/md.0000000000006501

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探討咀嚼口香糖與穴位按壓對結直腸切除術後病人腸道功能恢復之成效

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