| 摘要: | 研究背景：
高血壓是臨床上常見的病，是導致中風的主要因素。近年來很多臨床實證研究報告指出針刺太衝穴，對降血壓有良好的成效。研究亦顯示，穴位按壓與針刺同樣具有治療的效果。故建立中醫按壓降低血壓成效的實證資料，是護理人員推動高血壓病患中醫照護的基本課題，進而可將研究證實的穴位按壓方案，併入護理技術常規，以提升照護品質並可發揮護理獨立功能。
研究目的：
探討太衝穴按壓對高血壓病患之降低血壓及減輕頭暈、頭脹、頸部僵硬的效果。
研究方法：
本研究採實驗法。研究對象取自中部某醫學中心心臟內科門診之就診病患共80位，需符合下列條件：（1）有高血壓病史且收縮壓需介於150至180mmHg之間；（2）在收案前兩小時內無使用短效型降血壓藥物；（3）同意接受按壓；（4）年齡介於40至75歲。隨機分為實驗組及對照組各40位，實驗組實施穴位按摩（Acupressure），而對照組給予假按摩（sham）。實驗組按壓部位在個案右腳太衝穴。按壓方式採用右手大拇指垂直按壓，按壓5秒放鬆1秒，共30次，合計3分鐘，按壓力道約3公斤；對照組按壓部位在太衝穴旁約一寸之第一蹠骨上，按壓方式與時間，和實驗組相同。介入效果評估，以電子血壓計測量血壓，包括按壓前、按壓後立即、按壓後十五分鐘、按壓後三十分鐘。並詢問個案及自病歷收集相關資料。資料分析方法採次數、百分比、平均數、標準差、t檢定、pair-t檢定及Linear Mixed model重複測量檢定。
研究結果：
檢定兩組之基本資料及干擾因素，包含：年齡、性別、八小時內用藥、陽氣虛體質、陰血虛體質、痰濕瘀滯體質等。結果顯示實驗組與對照組個案在各項基本資料及干擾因素皆沒有達統計顯著性差異（p > 0.05），表示兩組具有同質性。比較按壓前後兩組間之降壓及頭頸部不適改善成效，兩組個案收縮壓及舒張壓在按壓後立即、按壓後15分和按壓後30分的降壓成效均具有顯著性差異（p < 0.05），而頸部僵硬在按壓後15分和按壓後30分達顯著性差異（p < 0.05），所以，本研究結果顯示穴位按壓具有改善高血壓患者之血壓及頸部僵硬的情況。
研究結論與建議：
太衝穴穴位按壓具有降低收縮壓及舒張壓的效果，而頸部僵硬部分雖然在按壓後15分後呈現效果，但仍需更多實證證據支持。建議將太衝穴位按壓方式列入高血壓病患的出院常規衛教，以及加入臨床護理人員在職教育課程及學校護理技術課程中，以提升護理人員獨立性照護高血壓個案的知能，進而提升照護品質。
Background:
Hypertension is a common disease, and a main factor leading to stroke. Recently, many clinical studies have shown that acupuncture over Taichong point is helpful in lowering blood pressure. Studies showed that acupressure and acupuncture have similar effect. Therefore, nursing scholars have suggested that the acupressure program should be put into nursing techniques to improve the quality of care and to enhance the independence of nurses. Establishing evidence base in acupressure is the basic issue of the nursing staffs to promote nursing care quality.
Objective:
The purpose of this study is to assess the effect of acupressure of Taichong point in reducing blood pressure, dizziness, stretching, neck stiffness effects in hypertensive patients.
Methods:
Experimental method was used, and study subjects were samples from the cardiology outpatient department patients in a medical center. Inclusion criteria were as below: 1) with history of hypertension and systolic blood pressure between 150 mmHg than 180mmHg; 2) no use of short-acting antihypertensive drugs within two hours before the acupressure; 3) with informed consent; 4) age between 40 and 75 years. Patients were randomly divided into experimental and control groups, each consisted of 40 patients who completed acupressure or sham. Method of massage: Experimental group: the experimental group patients accepted acupressure and the control group patients accepted sham. In the experimental group: patients received Taichong acupressure, by pressing vertically with the thumb, about three kilograms, and placing five seconds each time with rest of one second; repeated thirty times within three minutes. Controlled group: pressing the nearby point 1 inch transversely away from the Taichong point and just lying on the 1st metatarsal bone; the pressure method and time was the same as the experimental group.Evaluation of therapy: use electronics to measure blood pressure: before acupressure, immediately after acupressure, 15 minutes and 30 minutes after acupressure. Data was gathered from patients themselves or from their chart. Data analysis method includes frequency, percentage, mean, standard deviation, t test, pair-t test, and lineal mixed model repeated measures test.
Results:
The basic data and confounding factors including age, gender, the medication within 8 hours, and the constitution of patients including Yang-Xu, Yin-Xu, and Stasis type were compared. And the pre-tests did not reveal remarkable difference between in the experimental and control groups (p > 0.05). After the intervention, i.e. acupressure, there were obvious improvements in reducing blood pressure and relieving the neck discomfort. The blood pressure was obviously reduced immediately, 15 minutes, and 30 minutes after accepting acupressure (p > 0.05), so as the relief in neck discomfort 15 minutes, and 30 minutes later after the manipulation (p > 0.05). Our study revealed that acupressure could reduce the blood pressure and relieve the neck stiffness.
Conclusions:
Acupressure on taichong could reduce the systolic and diastolic pressure, but more evidence-based study should be performed to confirm the effects of acupressure in relieving neck stiffness especially 15 minutes later after the manipulation. We suggest the patients perform who have hypertension to taichong acupressure in daily life. And the schools should also teach nursing students about the use of taichong acupressure in hypertension patients to promote the care quality in clinical practice. |
