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    請使用永久網址來引用或連結此文件: http://ir.cmu.edu.tw/ir/handle/310903500/50376


    題名: 腹式呼吸訓練於口腔癌手術患者焦慮與生活品質之成效
    Effects of Abdominal Breathing Training on Anxiety and Quality of Life in Patients with Oral Cancer Following Surgery
    作者: 王謹賢;Chin-Hsien Wang
    貢獻者: 護理學系碩士班
    關鍵詞: 口腔癌;腹式呼吸訓練;焦慮;生活品質;Oral cancer;Abdominal Breathing Training;Anxiety;Quality of Life
    日期: 2013-08-31
    上傳時間: 2013-10-02 11:33:20 (UTC+8)
    出版者: 中國醫藥大學
    摘要: 研究背景：
    口腔癌患者從診斷到治療期間，都面臨著不同程度生理及心理層面的困擾，對生活品質也有潛在負面的影響。放鬆介入可有效改善口腔癌患者因疾病或治療所導致心理層面的困擾，並改善患者的生活品質；但目前研究文獻研究措施的介入都在於術後。
    研究目的：
    本研究的目的是探討腹式呼吸訓練於預手術之口腔癌患者住院期間在焦慮及生活品質之成效。
    研究方法：
    本研究採實驗型、隨機分配之研究設計。研究對象為中部某醫學中心預住院接受手術之口腔癌患者，收案31人並以區集隨機分配至腹式呼吸組或對照組。所有的參與者在住院期間會接受二次的腹式呼吸訓練，三次焦慮之心理指標醫院焦慮量表及焦慮視覺類比量表及生理指標心率變異性的測量，以及二次生活品質之頭頸癌症治療功能性評估量表的測量。統計資料以SPSS 17.0套裝軟體進行建檔及資料分析。統計方法包括描述性統計分析以平均數、標準差、人數和百分比陳述參與者基本屬性、醫院焦慮量表、焦慮視覺類比量表、頭頸癌症治療功能性評估量表及心率變異性之得分情形。推論性統計以卡方檢定、t檢定分析腹式呼吸組與對照組基本屬性、焦慮及生活品質於前測之差異，並運用廣義估計方程式分析腹式呼吸訓練介入對口腔癌手術患者於住院期間焦慮及生活品質之成效。
    研究結果：
    腹式呼吸訓練對於口腔癌患者住院期間焦慮的成效為有助於立即改善心理焦慮的感受；但對於維持住院期間焦慮改善的成效，未達到統計上顯著的差異。而生理焦慮指標研究結果顯示腹式呼吸組經由腹式呼吸訓練介入後，交感神經活性定量指標(LF norm)增加，副交感神經活性的定量指標(HF norm)下降，且兩組間達到統計上的顯著差異；然而，可由自律神經系統平衡指標(LF/HF ratio)反應出腹式呼吸組的患者住院期間自主神經系統一直是呈現某種程度的調控，以因應面對手術及治療所承受的焦慮與壓力。在住院期間生活品質之成效上，兩組患者於出院前生活品質皆有下降的趨勢，但未達統計上之顯著差異。
    研究結論與建議：
    護理人員可在患者住院接受手術治療前，甚至可提前至門診等待或是確立診斷後，立即運用焦慮、生活品質量表來確認患者心理焦慮的感受及治療前的生活品質。在患者確認有焦慮的症狀後，護理人員可藉由行為觀察、監測生命徵象和心率變異性的變化，客觀的評估焦慮的程度；並在門診或是病房提供衛教時，同時加上教導腹式呼吸訓練，幫助患者緩解焦慮。建議未來於臨床上可將腹式呼吸列入口腔癌患者照護常規中，以改善患者之焦慮，並能幫助提升治療期間及返家後的生活品質。
    Background:
    Patients with oral cancer suffered from the different levels of physical and psychological distress that negatively impact the quality of life. Evidence indicated that the implementation of the relaxation intervention improved patients’ psychological problems as well as quality of life, but the intervention was implemented after the surgery in the current relaxation literature.
    Purpose:
    The purpose of this study was to explore effects of abdominal breathing training on the anxiety and quality of life in patients with oral cancer following surgery during their hospitalization.
    Methods:
    The study was an experimental design with the block randomized assignment. A total of 31 participants were recruited from a medical center in Taichung, Taiwan. Participants were block randomly assigned to either the abdominal breathing training group or the control group. All the participants were measured two and three times for quality of life and anxiety, respectively. The instruments included Hospital Anxiety Scale, Visual Analog Scale-Anxiety, Heart Rate Variability, Functional Assessment of Cancer Therapy-Head and Neck Scale. The SPSS 17.0 for windows was used for data entry and analysis. Descriptive analysis with frequency, mean, and standard deviation and inferential analysis including t-test, chi-square, analysis of variance, and generalized estimating equation were performed for the study.
    Results:
    The results showed that abdominal breathing training significantly improved oral cancer patients’ psychological anxiety immediately but the significant effect did not maintain at the end of intervention. Results of physiological anxiety indicators including sympathetic activity (LF norm) and parasympathetic activity (HF norm) reached statistically significant differences between the two groups. However, the result of autonomic nervous system balance index (LF/HF ratio) has shown some degrees of regulation when patients exposed to the stress from surgery to prior to their discharge. There was no significant effect of abdominal breathing training on quality of life during their hospitalization.
    Conclusions:
    In the clinical settings, nurses are suggested to observe and monitor oral cancer patients’ anxiety and quality of life with subjective and objective tools, such as Visual Analog Scale-Anxiety, Hospital Anxiety Scale, and Heart Rate Variability. This will be able to detect patients’ problems earlier and to manage them easier. The abdominal breathing training is recommended to nurse to teach patients before their surgery based on results of this study. Following up the long term effect of abdominal breathing training is the future direction for research on these patients’home care.
    顯示於類別:[護理學系暨碩士班] 博碩士論文

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