有氧運動及熱敷對於腹腔鏡手術後氣痛及上腹痛改善之成效

背景: 病人腹腔鏡手術比傳統剖腹的疼痛小，復原快。但腹腔鏡手術過程使用二氧化碳氣體打入體內以求手術視野清晰，因而使病人在術後可能產生氣痛及上腹痛造成不適。目的:評估有氧運動及熱敷對於腹腔鏡手術後氣痛及上腹痛改善之成效方法:採隨機分派研究設計。於2021年1月至4月，於中部某醫學中心婦產科病房接受腹腔鏡手術病人122人為研究對象，實驗組62人及對照組60人。於腹腔鏡手術後4小時病人於麻藥清醒後，實驗組於術後4、6、12、24小時執行ABC有氧運動介入含上肢擴胸運動(Activity)、深呼吸(Breathing)及雙肩熱敷(hot Compress)，每次5-10回共30分鐘。控制組則依病房常規照護。以視覺疼痛評估量表(VAS)及術後恢復品質量表(QoR-40)測量介入成效。使用個數、百分比、平均值、標準差等描述性統計及卡方、配對t檢定、t檢定等推論性統計分析資料。結果: 實驗組及對照組之基本資料如年齡、手術方式、手術時間、術後血紅素、體溫、BMI值及術後4小時疼痛分數，均無統計顯著差異，顯示其同質性高。術後24小時，實驗組與控制組，發生雙肩氣痛VAS平均分數分別為0.13±0.59 vs.0.87±2.28(P<.05)及右肩氣痛0.25±0.93 vs. 1.78±2.6(P<.001)。術後恢復品質量表中實驗組與控制組疼痛分數分別為27.2±4.36 vs 24.47±7.93( P<.0001)。然而於情緒狀態、生理舒適、心理支持及生理獨立性則兩組無顯著差異。結論:本研究設計之ABC有氧運動介入含上肢擴胸運動(Activity)、深呼吸(Breathing)及雙肩熱敷(hot Compress)有助於改善腹腔鏡術後疼痛，本研究結果能提供實證性臨床照護之參考應用。

關鍵字

腹腔鏡手術；有氧運動；氣痛；肩痛；熱敷

並列摘要

Background: The patient's laparoscopic surgery has less pain and faster recovery than traditional laparotomy. However, during laparoscopic surgery, carbon dioxide gas is used to infiltrate the body in order to obtain a clear vision of the operation. As a result, the patient may have gas pain and upper abdominal pain after the operation, which may cause discomfort. Objective: To evaluate the effects of aerobic exercise and hot compress on air pain and upper abdominal pain after laparoscopic surgery Methods: The research was conducted as randomized controlled trial. From January to April 2021, 122 patients underwent laparoscopic surgery in the obstetrics and gynecology ward of a medical center in the central part of the country were the research subjects, 62 in the experimental group and 60 in the control group. 4 hours after the laparoscopic surgery, the patient was awake with anesthetics, and the experimental group performed ABC aerobic exercise intervention including upper extremity chest expansion exercises (Activity), deep breathing (Breathing) and shoulder warm compresses at 4, 6, 12, and 24 hours after surgery. (hot Compress), 5-10 times each time for a total of 30 minutes. The control group followed the routine care of the ward. The effect of intervention was measured by the Visual Pain Scale (VAS) and the Quality of Postoperative Recovery Scale (QoR-40). The statistical methods used include descriptive statistics (number, percentage, average, standard deviation) and inferential statistics (chi-square, paired t-test and t-test). Results: The basic data of the experimental group and the control group, such as age, operation method, operation time, postoperative hemoglobin, body temperature, BMI value, and pain score of 4 hours after operation, showed no statistically significant difference, indicating high homogeneity. Twenty-four hours after surgery, the average VAS scores for shoulder air pain in the experimental group and the control group were 0.13±0.59 vs. 0.87±2.28 (P<.05) and 0.25±0.93 vs. 1.78±2.6 (P<. 001). The pain scores of the experimental group and the control group in the postoperative recovery quality scale were 27.2±4.36 vs 24.47±7.93 (P<.0001). However, there were no significant differences between the two groups in emotional state, physical comfort, psychological support, and physical independence. Conclusion: The ABC aerobic exercise intervention designed in this study includes upper extremity chest expansion exercises (Activity), deep breathing (Breathing) and shoulder hot compresses (hot compress) to help improve postoperative pain after laparoscopic surgery. The results of this study can provide reference applications for clinical care.