穴位按摩對肝硬化病人腹水症狀、疲憊與生活品質之改善成效

背景：肝硬化是個慢性持續性疾病，腹水是眾多合併症之一且常反覆發生，這影響了病人的呼吸、活動力，使人感到無力，疲憊程度增加、生活品質降低。目的：檢視穴位按摩介入對改善肝硬化病人腹水症狀、疲憊程度及生活品質的成效。方法：採縱貫式類實驗研究設計，自高雄某醫學中心取樣23位肝硬化病人，以測量腹圍、填寫個人疲憊強度及慢性肝病生活品質問卷收集資料，以SPSS 17.0版做平均數、百分比、卡方檢定、Mann-Whitney U、GEE等統計方法進行分析檢定。結果：統計結果發現，腹圍在四次追蹤時，改善程度都未達顯著性（β=-7.33，p>.05、β=-5.29，p>.05、β=-5.18，p>.05、β=-3.59，p>.05）；疲憊程度在四次追蹤時，改善程度都達負向顯著差異（β=-41.86，p<.001、β=-28.88，p<.001）β=-26.63，p<.001、β=-13.62，p<.05）；生活品質在四次追蹤時，改善程度都達顯著差異（β=60.29 p<.001、β=44.13, p<.001、β=38.47, p<.001、β=19.68, p<.05）。結論：穴位按摩對肝硬化病人腹水減少成效較未達顯著性、穴位按摩對肝硬化病人疲憊程度降低具有實證成效、穴位按摩對肝硬化病人生活品質提升具有實證成效。臨床應用：穴位按摩對肝硬化病人腹水減少成效較不顯著，但可有效改善肝硬化病人之疲憊程度與生活品質。研究結果可供護理臨床工作者對肝硬化病人照顧之參考。

關鍵字

肝硬化；腹水；疲憊；生活品質；穴位按摩

並列摘要

Background: Liver cirrhosis is a chronic, progressive, and has many accompanying symptoms. Ascites is the most common symptom in patients with liver cirrhosis. It can affect patients’ breathing, mobility, increase fatigue and lower the quality of life. Purpose: To explore the effects of acupressure on ascites, fatigue, and quality of life in patients with liver cirrhosis. Methods: A longitudinal, quasi-experimental study. Random sampling was used to recruit 23 liver cirrhotic inpatients from one hospital. Abdominal circumference measuring, and two structured questionnaires, including the Checklist Individual Strength Questionnaire - Chinese Version, and Chronic Liver Disease Questionnaire - Traditional Chinese (Mandarin) (Taiwan), were used for data collection. Results: The statistics results demonstrated significant differences between the states of fatigue, and quality of life among patients in the experimental group and those in the control group（β=-41.86，p<.001、β=-28.88，p<.001）β=-26.63，p<.001、β=-13.62，p<.05; β=60.29 p<.001、β=44.13, p<.001、β=38.47, p<.001、β=19.68, p<.05）. But the statistics results no significant differences between the states of abdominal circumference among patients in the experimental group and those in the control group（β=-7.33，p>.05、β=-5.29，p>.05、β=-5.18，p>.05、β=-3.59，p>.05）. Conclusion: The results indicate that acupressure improved fatigue, and quality of life in liver cirrhotic patients. However, there is no significant differences in reduce the abdominal circumference. Implication for practice: Although the acupressure has no significant differences in reduce the abdominal circumference. The results indicate that acupressure improved fatigue, and quality of life, these results still can be considered by nurse practitioners seeking alternative methods for the care of liver cirrhotic patients.