| 摘要: | 本研究旨在搜尋以穴位按摩為主要介入措施之臨床實驗性研究，檢視其適用對象/症狀、操作手法、照護成效及研究方法品質，以提出穴位按摩方案在護理實務的應用。
本研究以質性系統性文獻回顧法（qualitative systematic review）搜尋1994至2005這十二年間，發表於MEDLINE、中國期刊全文資料庫、中華民國期刊論文索引以及台灣博碩士論文資訊網，鍵入下列關鍵字：「穴位按摩、指針、指壓、穴位點壓、點穴及acupressure」，選取符合篩選標準並排除重複出現，共找出68篇與穴位按摩相關之隨機分派或具控制對照組之臨床實驗性研究（RCT及CCT），進行文章的分析與整理。
結果顯示（1）從68篇文章中，由第一作者的身分及執行穴位按摩的場所得知，護理人員是提供相關研究多的人，而穴位按摩場所多為護理人員的工作職場。（2）68篇文章，其穴位按摩照護成效均呈正向結果。（3）68篇文章中，部分文章研究設計不夠嚴謹，經排除單篇無法歸納或經Jadad 分數表研究品質評為1分的RCT文章，綜合32篇文章，本研究發現穴位按摩技術常用於下列8個症狀：即①噁心嘔吐症狀；②原發性痛經；③產痛；④疲憊、憂鬱問題；⑤睡眠障礙；⑥焦慮；⑦呼吸困難問題；⑧促進腸胃道蠕動。（4）分析穴位按摩操作手法包括：以溫和堅定，均勻而柔和的手法，採環形按揉、垂直按壓或兩者交替進行；從輕手法開始逐漸加重至3-5公斤的壓力，但須依個案年齡、性別、皮膚厚薄而有個別差異，隨時評估個案主觀感受，使穴位按摩處有酸、麻、脹、重、溫、電傳等“得氣”的感覺，這個力度必須是個案能忍受的，且按摩後個案會感到舒適，依此原則來調整按摩力度；平均每穴按摩3-5分鐘，包括按摩前的放鬆及選穴多寡的考量，單次穴位按摩療程建議在10-15分鐘左右完成。
本研究結果，提供穴位按摩適用對象/症狀及操作手法訊息，有助於臨床護理人員及護生學習穴位按摩照護措施，並發展穴位按摩標準作業流程。檢視研究方法品質，提供穴位按摩未來研究方向及研究設計建議。
The purpose of this study was to search articles with clinical control trials (CCT) or randomize control trials (RCT) that involved acupressure treatment, and review their research quality and caring effects. After concluding and integrating, the application of acupressure including suitable objects/symptoms was submitted and applying acupressure to nursing practice was suggested.
Data were collected from 1994 to December 2005. Literature published in ‘MEDLINE’, ‘CJN’, ‘Chinese Journal and Thesis Index’, and ‘Taiwan Thesis Net for Doctor and Master’ were searched by inputting keywords of ‘acupressure.’ As a result, 68 articles about acupressure were found to include in the current study. These articles were sorted and analyzed by qualitative systematic review, and inspected their researching method quality and caring effects. Finally, the acupressure application in nursing practice, including suitable objects/symptoms and operation techniques were raised.
The results showed as followed
1. From the primary authors and description about acupressure executing places in the above 68 articles, it is known that nursing staff get the most chances to provide and conduct acupressure caring.
2. The effects of acupressure leaded to the positive results in these 68 articles.
3. There are 32 articles left after eliminating articles with insufficient researching quality, miscellaneous in caring scope, or only 1 score by Jadad Score evaluation from these 68 articles. Among the 32 articles, acupressure techniques using in the following 8 symptoms were recommended in this study: i) nausea and vomiting, ii) primary dysmenorrheal, iii) labor pain, iv) fatigued and depression, v) improving the quality of sleep, vi) anxiety, vii) Respiratory, and viii) increased gastrointestinal motility.
4. Acupressure techniques including: Massage could be proceeded in circular knead, vertical press, or alternative way with moderate, steady, uniform and tender strength. From the beginning of acupressure, the strength should be mild and gradually added to 3 - 5 kg varying depend on objects’ age, sex, and skin thickness. It is able to adjust the strength of massage to make the objects comfortable by using durable strength and frequently evaluating if the objects had feelings of ‘chi’ of ache, numbness, bloat, heaviness, warm, and electrical transmission. It is the principles to adjust the strength of massage. It is suggested 3-5 minutes for each acupressure point, and 10-15 minutes for whole massage process including relaxation and consideration of acupressure points before massage.
The result of this study was helpful for clinical nursing staff and student nurses to learn acupressure as well as to develop acupressure standard operation process, due to provide suitable subjects/ symptoms information of operation technique. Besides, it also provided future research direction and design. |
