運用針灸緩解癌症病人呼吸困難：系統性文獻回顧

背景：呼吸困難是種主觀不適的感受，癌症病人約有90%因呼吸困難症狀而困擾，癌症呼吸困難常常不是單一治療就可以緩解，需要合併治療來偕同改善，在臨床上已開始運用針灸治療緩解癌症病人呼吸困難，然而迄今未有一致性治療準則，與缺乏系統性文獻回顧探討其成效為何。目的：探討針灸治療對減緩癌症呼吸困難之成效與臨床應用。方法：以系統性文獻回顧方式，彙整介入措施為針灸治療，中、英文隨機試驗研究，運用PICO（participant, intervention, comparison, outcome）設立關鍵字為癌症、呼吸困難、針灸等，搜尋電子期刊資料庫PubMed、CINAHL、MEDLINE、PsycINFO、Cochrane Library、WOS、Embase、華藝線上圖書館、台灣碩博士論知識加值系統網、中國知識資源總庫，設定搜尋年限為資料庫開始收錄至2018年7月31日前所發表之文獻，經篩選、刪除重複及評讀後，將納入文獻以The Cochrane Collaboration’s tool for assessing risk of bias評定文獻品質。結果：文獻搜尋共123篇，經刪除重複、檢視文獻標題、摘要與內文後，最後納入4篇文獻進行系統性文獻回顧，結果顯示以針灸合谷、華蓋、璇璣、肺俞、風門、足三里、耳朵肺位置治療癌症呼吸困難，在治療結束後30分鐘有顯著緩解呼吸困難之成效、附帶成效在治療後第七天與第十四天在生活品質上有顯著差異、在治療後第七天焦慮症狀上有顯著差異、放鬆程度上在任何時間點均有顯著差異、憂鬱症狀無顯著差異。結論/實務運用：本研究結果顯示針灸治療可有效緩解癌症呼吸困難、焦慮、提升生活品質與增加病人放鬆，故在常規治療下，建議可增加針灸治療作為緩解呼吸困難之輔助療法之一。

關鍵字

癌症；呼吸困難；針灸；系統性文獻回顧

並列摘要

Background: Dyspnea is a subjective discomfort which burdens most cancer patients. Combined several complementary therapies are essential to relieve the dyspnea of cancer patients, while using a single treatment is usually not avail. Acupuncture has been applied to treat it in clinical practice recently, however, there is lack of a consistent conclusion and systematic review articles to exam its effectiveness. Objective: Investigating the effectiveness and the clinical applications of acupuncture treatment for relief of dyspnea of cancer patients. Method: Systematic reviewing was used to archive the Chinese and English academic articles with randomized control trials (RCT), which aimed acupuncture as an intervention. Key words for searching were cancer, dyspnea, acupuncture, etc., which were applied PICO (participant, intervention, comparison, outcome) to set. The databases for searching included PubMed, CINAHL, MEDLINE, PsycINFO, Cochrane Library, WOS, Embase, Airiti Library, National Digital Library of Theses and Dissertations in Taiwan, and China National Knowledge Infrastructure. Articles from the initial of the database to July 31, 2018 were included and were introduced into Cochrane Collaboration’s tool for assessing risk of bias to evaluate the quality of the articles. Results: There were 123 articles were included initially. After deleting the duplication, and reviewing the title, the abstract and the content of each article, 4 articles were enrolled into the final analysis. The results showed that the participants’ breathlessness was significantly relieved in 30 minutes after an acupuncture intervention at LI 4,RN20,RN21,BL12,ST36, Auricular lung point,and acupuncture alone showed significant effects in their quality of life, relaxation levels, and anxiety reduction in the 7-day follow-up. However, it did not alleviate their depressed symptoms. Conclusion/ Application in practice: The results showed that the acupuncture treatment effectively alleviates the breathlessness and anxiety in cancer patients, and it also improves their quality of life and the relaxation levels. Thus, under a routinely treatment protocol, acupuncture can be suggested to be one of the complementary alternative treatments.