穴位指壓改善大腸癌患者合併結腸切除胃腸功能障礙之成效

大腸直腸癌已連續多年成為國人好發之癌症，且有逐年增長之趨勢，目前臨床上常運用腹腔鏡做大腸切除，但執行腹腔鏡時，必需以二氧化碳灌注製造一個正壓氣腹，因此術後常造成患者腹脹、噁心嘔吐等胃腸功能障礙。本研究目的旨在探討穴位指壓介入對大腸癌術後患者胃腸功能障礙之成效。研究使用類實驗設計，針對大腸癌合併腹腔鏡手術後患者以隨機方式分成實驗組A、B及對照組C各18人，實驗組A和B於術後當天至第三天由研究者執行穴位指壓，實驗組A按壓足三里+內關，實驗組B按壓足三里穴，每一穴位按壓三分鐘，分別為12及6分鐘，對照組C則採一般常規照護，藉由穴位指壓介入了解大腸癌術後患者的腸蠕動、噁心嘔吐及腹脹改善成效。研究結果顯示，在腸蠕動方面，實驗組A（p＜0.018）和B（p＜0.001）較對照組C腸蠕動次數有顯著差異，顯示穴位指壓介入後實驗組A和B腸蠕動次數優於對照組C，且實驗組B的成效優於實驗組A；在羅氏噁心嘔吐量表部份，實驗組A（p＜0.006）和實驗組B（p＜0.020）較對照組C達顯著性差異，且實驗組A改善程度優於實驗組B；在腹脹程度部份，實驗組A和B在視覺類比量表較對照組C有顯著差異（p＜0.001），有無腹脹風險比呈現實驗組A（p＜0.001）和實驗組B（p＜0.001）較對照組C有顯著差異、顯示實驗組A和B在接受穴位指壓後腹脹改善程度優於對照組C，且實驗組B效果優於實驗組A。整體而言，穴位按壓可以改善研究對象的胃腸功能障礙，足三里穴在增進腸蠕動次數及緩解腹脹程度有其重要地位，而內關穴在噁心嘔吐的改善也佔有顯著的角色，建議往後在臨床實務面能將此穴位指壓納入大腸術後患者的護理指導，以增進病患胃腸功能恢復，提昇術後之照護品質。

關鍵字

大腸癌；穴位指壓；胃腸功能

並列摘要

The purpose of this research is to explore the effectiveness of acupressure in patients with gastrointestinal dysfunction. Colonrectal cancer has become a common disease for many years in Taiwan and there is a tendency for an increasing incidence of this disease recently. The laparoscopic resection of the intestine is the most popular treatment for patients with colon cancer in clinical practice; however, a positive pressure pneumoperitoneum must be instilled with carbon dioxide when performing laparoscopy. This may cause patients to have abdominal distention, nausea, vomiting, among other symptoms. Therefore, this research aims to understand the benefit of acupressure in dealing with intestinal peristalsis, nausea/vomiting, and abdominal distension for patients with colon cancer. A single-blind quasi-experimental design is used, with the research subjects randomly divided into experimental group A, B, or control group C. There were eighteen participants in each group. Participants in experimental group A pressed ST36 and PC6, while experimental group B pressed ST36. Both groups had applied acupressure by the researcher after surgery was completed, and this treatment continued for the next three days. Each acupoint was pressed for three minutes. The total intervention time of acupressure was 12 minutes and 6 minutes respectively in these two groups. The participants in the control group were provided with general care for four days. The results showed that there was a significant difference in intestinal peristalsis between the experimental group A (p<0.018), B (p<0.001) and the control group C. This indicates that the number of bowel movements in the experimental group A and B was superior compared to control group C after the acupressure intervention. The results of experimental group B were also better than experimental group A. In the Rhodes Index of Nausea and Vomiting Scale, experimental group A (p<0.006) and experimental group B (p<0.020) were significantly different from control group C, and experimental group A has a better effect than experimental group B. In the degree of abdominal distension, experimental groups A and B were significantly different in the Visual Analogue Scale compared to control group C (p<0.001). In comparison to control group C, the risk of non-abdominal distension was greater in experimental group A (p<0.001) and experimental group B (p<0.001). This shows that experimental group A and B had improvements in abdominal distension after acupressure compared with control group C. Experimental group B also had better relief effects in abdominal distension than experimental group A. In conclusion, acupressure can improve gastrointestinal dysfunction in patients with colon cancer. ST36 has an important role in increasing intestinal peristalsis and relieving abdominal distension. PC6 plays a significant role in descreasing the incidence of nausea and vomiting. It is recommended that health workers utilize acupressure as postoperative education guidance for patients with colon cancer in clinical practice. Acupressure can not only recover patients’ gastrointestinal function, but can also improve the quality of postoperative care.