放鬆反應於改善癌症末期病患之疼痛程度、情緒狀態及生理反應之成效

Effects of Relaxation response on Levels of Pain, Emotional State, and Physiological Response among Terminal Cancer Patients

呂美嬅(Lu Mei-Hua)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學研究所/碩士(2002年)

摘要

高達60-90 %的末期癌症病人為嚴重疼痛所苦，疼痛會加深負向情緒的變化，而焦慮、憂鬱等心理困擾也會強化疼痛的感覺。本研究目的為探討進行性肌肉鬆弛處置對於末期癌症病人之疼痛程度、情緒及生理反應成效。研究採實驗設計法與前、後測收集資料，以方便取樣於二所區域教學醫院腫瘤科病房選取符合條件之癌症末期病人，將病患依隨機方式分配至對照組、實驗組1（進行性肌肉放鬆錄音帶訓練）及實驗組2（進行性肌肉放鬆合併生物回饋），三組人數分別為12、9與7人，共計28人。對照組只接受一般病房之常規照護，兩組實驗組則給予連續四天，每天一次，長約25分鐘之放鬆措施，於措施介入前填寫簡明疼痛量表及簡式症狀量表，並測量生理反應指標，於介入後填寫簡式症狀量表、評估訪談當時疼痛程度，並測量生理反應指標。資料以描述性統計、多元迴歸及無母數分析。結果發現：（1）對照組之疼痛對生活影響程度、情緒狀態及生理反應指標隨著住院天數而增加，疼痛程度則有下降趨勢。（2）接受肌肉放鬆錄音帶訓練之病患，整體疼痛程度改善成效未達顯著水準，而整體疼痛對生活影響程度之緩解達統計上顯著差異（z=-2.43, p＜0.05）；整體憂鬱情緒改善達統計上顯著差異（z=-2.38, p＜0.05），焦慮及敵意則未達顯著水準；整體呼吸生理指標變化達統計上顯著差異（z=-1.95, p＜0.05）。（3）接受肌肉放鬆合併生物回饋之病患，整體疼痛程度改善成效未達顯著水準，而整體疼痛對生活影響程度之緩解達統計上顯著差異（z=-2.37, p＜0.05）；整體憂鬱及焦慮情緒改善達統計上顯著水準（z=-2.21, p＜0.05；z=-1.99, p＜0.05）；生理指標方面，整體收縮壓變化達統計上顯著差異（z=-2.21, p＜0.05）。

關鍵字

癌症末期 ； 癌症疼痛 ； 肌肉放鬆 ； 生物回饋

並列摘要

About 60-90 % terminal cancer patients are suffering from severe pain. The purpose of this study was to evaluate the effect of relaxation response on relieving levels of pain, emotional state, and physiological responses among terminal cancer patients. A pre-post test experimental design was used in this study. A convenience sample from oncology wards in two local teaching hospitals were recruited. Patients were randomly assigned to control group, experimental groupⅠ(PMR tape training) and experimentalⅡ(PMR tape combined with biofeedback training). There were 12 eligible participants in the control group, 9 in the experimentalⅠgroup, and 7 in the experimentalⅡgroup. The control group accepted routine care, and two experimental groups accepted about twenty-five minutes relaxation intervention once a day for four days. Before and after the treatment, participants completed the Brief Pain Inventory (BPI), the Brief Symptom Rating Scale (BSRS), and measures of physiological responses. Data were analyzed by using descriptive statistics, and nonparametric statistics. The major findings of this study were as follows: (1) In the control group, pain interference, emotional state, and physiological responses increased during these 4 days. (2) In the PMR group, pain interference (z=-2.43, p＜0.05), levels of depression (z=-2.38, p＜0.05), and the respiratory indicator (z=-1.95, p＜0.05) decreased significantly after the treatment. (3) In the PMR combined biofeedback group, pain interference (z=-2.37, p＜0.05), levels of depression (z=-2.21, p＜0.05), levels of anxiety (z=-1.99, p＜0.05), and systolic blood pressure (z=-2.21, p＜0.05) decreased significantly after the treatment. The results of this study support the effectiveness of relaxation response on levels of pain, emotional state, and physiological response among Taiwanese terminal cancer patients.

並列關鍵字

terminial ； cancer pain ； muscle relaxation ； biofeedback

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