穴位指壓對接受化學治療的頭頸癌病人的睡眠品質、疲憊與能量之成效：Rogers護理理論之應用

本研究目的在探討穴位指壓對接受化學治療的頭頸癌病人的睡眠品質、疲憊與能量（感知能量與經絡能量）之成效。本研究採立意取樣，樣本來自南部某一醫學中心的頭頸癌病人之匹茲堡睡眠品質分數大於5分以上者58位。本研究採實驗設計，控制有服安眠藥、年齡及性別（以男性為主），以隨機分配至實驗組25人與控制組33人。實驗組接受二週之穴位指壓方案，每週5天，每天執行2次，早晚各1次，每次12分鐘，但控制組不接受穴位指壓方案，58位個案於一個月期間進行5次資料收集。研究工具包括：個人屬性與疾病特性量表、Richards-Campbell睡眠量表、匹茲堡睡眠品質量表、修訂Piper疲憊量表、疲憊視覺類比量表之能量次量表、安適圖量表、穴位指壓可信度自評表及經絡能量檢測儀。所收集的資料以描述性統計、卡方檢定、獨立樣本t檢定、配對樣本t檢定、單因子變異數分析、重複量數二因子變異數分析、重複量數三因子變異數分析及皮爾森積差相關分析等進行統計分析。結果顯示：在成效方面，穴位指壓能顯著增進接受化學治療的頭頸癌病人每天的睡眠品質及回溯一個月前之睡眠品質，在主觀睡眠品質、睡眠時數、睡眠效率、睡眠潛伏期、睡眠困擾等也呈現有改善效果。不僅如此，在疲憊部份，在整體的疲憊和疲憊之認知卅情緒也有顯著降低。並且在能量部份也有顯著提高（疲憊視覺類比量表之能量次量表）。但在PSQI睡眠品質之安眠藥使用、白天功能狀態，疲憊之行為卅嚴重度、情緒的意義、感受，感知能量（安適圖量表）及24個經絡能量、平均經絡能量、上肢與下肢比值、左血右氣、陰陽比值等均無顯著成效。在相關方面，實驗組後測Ⅱ，RCSQ睡眠品質與穴位指壓之可信度有顯著正相關；前測頭頸癌病人及後測Ⅳ實驗組，疲憊視覺類比量表之能量次量表的分數與安適圖量表的分數，分別有高度、中度正相關。但實驗組後測Ι，RCSQ睡眠品質與穴位指壓之可信度無顯著相關；後測Ι、後測Ⅱ及後測Ⅲ，實驗組疲憊視覺類比量表之能量次量表的分數與安適圖量表的分數，無顯著相關；前測頭頸癌病人與後測Ι、後測Ⅱ、後測Ⅲ及後測Ⅳ實驗組，在疲憊視覺類比量表之能量次量表的分數與安適圖量表的分數，分別與平均經絡能量值皆無顯著相關。另外，前測頭頸癌病人比健康人在左手及右手（肺經、心包經、心經、小腸經、大腸經）、左腳及右腳（脾經、膀胱經）、右腳胃經、平均經絡能量、陰陽比值皆顯著較低，其餘部份皆無顯著差異。在前測、後測Ι及後測Ⅱ，實驗組、控制組比健康人在平均經絡能量皆顯著較低。在後測Ⅲ及後測Ⅳ，實驗組、控制組比健康人在平均經絡能量皆無顯著差異。在後測Ι，實驗組比健康人在陰陽比值有顯著較低，但控制組比健康人在陰陽比值無顯著差異。在前測、後測Ⅱ、後測Ⅲ及後測Ⅳ，實驗組、控制組比健康人在陰陽比值皆無顯著差異。在前測、後測Ι、後測Ⅱ、後測Ⅲ及後測Ⅳ，實驗組、控制組比健康人在上肢與下肢比值、左血右氣皆無顯著差異。依據結果並參考文獻，建議未來的研究，若穴位指壓週數能延長至四週，持續介入的療效應會更加突顯。在評值成效時，亦建議可於穴位指壓介入後的20或60分鐘內，即進行經絡能量的後測，可能會見到穴位指壓介入後，對經絡能量明顯的提升。另外，在這研究每一次的測量資料，能量在不同量表測試中呈現不一，到底何謂能量？能量是否可以使用安適圖量表來測量之？未來的研究，可以合併質性、量性研究方法來進一步探討和澄清能量與安適之關係。以及主觀能量與客觀的平均經絡能量是不同的，亦建議未來研究能進一步釐清主觀能量與客觀的平均經絡能量（體能）的差異性。期望本研究結果可供醫護人員提供給接受化學治療的頭頸癌病人改善睡眠品質、疲憊與能量之參考。

關鍵字

穴位指壓；頭頸癌病人；睡眠品質；疲憊；能量

並列摘要

The purpose of this study is to examine the effectiveness of acupressure in regards to the Quality of Sleep, Fatigue and Energy (perceived energy and meridian energy) of Head and Neck Cancer Patients receiving Chemotherapy. Purposive sampling is used in this study of 58 Head and Neck Cancer Patients (PSQI＞5) receiving Chemotherapy from the Head and Neck Cancer units of a medical center in Southern Taiwan. An experimental design is used for this study. By controlling the effect of hypnotics, age, and gender (male), subjects are randomly assigned to either an experimental group or a control group. The experimental group has 25 subjects, and the control group has 33 subjects. The total sample size is 58 subjects. The experimental group received two weeks of acupressure protocol. The sessions were conducted five days per week, two times per day with one session in the morning and one in the evening. Each session lasted 12 minutes. The control group did not receive the acupressure protocol. Five series of data were collected from the fifty eight subjects during the one month experiment. Research instruments include the Demographic Inventory of Patients, Pittsburgh Sleep Quality Index, Richards-Campbell Sleep Questionnaire, Revised Piper Fatigue Scale, Fatigue Visual Analogue Scale of Energy Subscale, The Well-Being Picture Scale, Credibility of Acupressure Rating Scale, and Ryodraku. Statistical analysis of all collected data were performed with descriptive analysis, Chi-Square, two-sample t-test, paired t-test, one-way ANOVA, two-way ANOVA with repeated measures, three-way ANOVA with repeated measures, and Pearson’s product-moment correlation. Results: Acupressure significantly improved the quality of daily sleep, as well as the sleep quality in the previous one month of Head and Neck cancer patients receiving chemotherapy. Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance were all significantly improved. Fatigue and the cognitive/mood of fatigue went down significantly. Subject’s energy was also significantly better (Fatigue Visual Analogue Scale of Energy Subscale). But the use of sleep medication and daytime dysfunction of Pittsburgh Sleep Quality Index; behavioral/severity; affective meaning, and sensory of fatigue; perceived energy(Well-Being Picture Scale); and 24 meridian energy, average meridian energy, upper and lower limbs ratio, left blood and right qi, yin yang ratio prove not to affect energy significantly. In experimental group, during post measure, there was a significant positive relationship between the Richards-Campbell Sleep Questionnaire and Credibility of Acupressure. Pre measure Head and Neck cancer patients and experimental group post measure Ⅳ, experienced energy and well-being that had a significantly high, medium positive relationship between Fatigue Visual Analogue Scale of Energy Subscale and the Well-Being Picture Scale. But experimental group post measure Ι did not show a significant association between the Richards-Campbell Sleep Questionnaire and the Credibility of Acupressure. Experimental group post measure Ι, post measureⅡ, and post measureⅢ were found not to have according to the Fatigue Visual Analogue Scale of Energy Subscale and Well-Being Picture Scale, energy that did not significantly correspond with their well-being. The Fatigue Visual Analogue Scale of Energy Subscale and Well-Being Picture Scale of the pre measure Head and Neck cancer patients and experimental group post measure Ι, post measureⅡ, post measureⅢ, and post measure Ⅳ did not have a significant correlation with the average value of meridian energy. In addition, pre measure head and neck cancer patients were found to have a significantly lower value of lung meridian, pericardium meridian, heart meridian, small intestine meridian, and large intestine meridian (on left and right hands), lower value of spleen meridian and bladder meridian (on left and right legs), lower value of stomach meridian on the right leg, lower average meridian energy, and a lower yin yang ratio than the healthy people. The rest had no significant difference. Subjects in both experimental groups and control groups were shown to have a significantly lower average value of meridian energy than that of healthy people in pre-measure, post-measure I and post-measure II. In post-measure III and IV, no significant difference was detected in the average value of subjects in the experiment and control groups as well as a healthy person. In post-measure I, those in the experiment group tended to have a lower yin yang ratio than that of a healthy adult. However, there was no significant difference in the yin yang ratio of those in the control group and a healthy adult. There was no significant difference in the yin yang ratio of subjects in the experimental group, control group and healthy individuals in pre-measure, post-measure II, post-measure III, and post-measure IV. In pre-measure, post-measure I, post-measure II, post-measure III, and post-measure IV, subjects in both the experiment group and control group did not display a significant difference in upper limb and lower limb ratio and left blood right qi than healthy individuals. Based on the research results and a thorough literature review, we suggest that four week long acupressure research study be conducted. Continuous intervention shall result in better treatment effectiveness. On the other hand, when evaluating effectiveness, post measure of meridian energy value should be taken within 20 or 60 minutes after the introduction of acupressure intervention. An improvement in meridian energy level will be observed. Furthermore, in every measurement of this study, since the energy level is shown differently in the different measures, we may ask what energy is and whether we are able to measure energy with The Well-Being Picture Scale. In the future, both qualitative and quantitative study shall be conducted to discuss and clarify the relationship between well-being and energy. Due to the difference of subjective energy measure and objective measure of the average value of meridian energy (physical fitness), this study also proposes that relevant studies shall be conducted to sort out the difference between them. This study serves as a reference for medical practitioners to help improve sleep quality, fatigue problems, and energy levels of Head and Neck cancer patients receiving chemotherapy.