| 摘要: | 本研究目的探討耳穴貼壓介入對社區康復之家思覺失調症個案便祕改善成效：採用交叉隨機試驗設計(crossover randomized controlled trial)，針對北部某四間康復之家思覺失調症具便祕困擾之住民為研究對象，採用簡單隨機分派方式將四家參與研究康復之家分成實驗?I（13位)及實驗組II（10位）；實驗組I先給予8週耳穴貼壓介入，而後6週廓清期(wash-out period)後接受常規照護；實驗組II先接受常規照護，而後6週廓清期後接受8週耳穴貼壓介入；耳穴貼壓主要由研究人員於大腸、直腸、三焦、神門耳穴穴位執行磁珠貼壓，磁珠耳貼留置於單側耳廓，每5天後移除，休息2天，隔週再由研究人員協助更換磁珠耳穴貼至對側耳之相應耳穴，受試者需每天執行2次耳穴穴位按壓，每處穴點按壓至少22下，按壓力道為使局部產生酸、脹、痛、麻、熱感；常規照護主要維持日常活動；二組受試者資料收集時間包含：介入前及介入後八週，測量變項及工具包含：(1)客觀便祕症狀：使用布里斯托糞便性質量表(Bristol Stool Form scale, BSF scale)、個案近一週排便次數進行資料收集；(2)主觀便祕症狀：使用病人自評便祕症狀量表(Patient Assessment of Constipation Symptoms, PAC-SYM)進行資料收集；(3)心率變異率：以心率變異率評估儀器量測住民心率變異情形。研究結果顯示，耳穴貼壓介入對主觀便祕症狀改善成效，PAC-SYM量表總分結果顯示，介入組於介入後比未介入組平均分數減少15.50分（p<0.001）；腹部症狀方面，介入組於介入後比未介入組平均分數減少3.21分（p<0.001）；直腸症狀方面，介入組於介入後比未介入組平均分數減少4.27分（p<0.001）；排便症狀方面，介入組於介入後比未介入組平均分數減少8.01分（p<0.001），表示經由耳穴貼壓介入有助降低主觀便祕症狀；在客觀便祕症狀改善成效結果顯示，近一週排便次數方面，耳穴介入組於介入後比非耳穴介入組平均排便次數增加3.96次(p<0.001)；BSF Scale方面，耳穴介入組在介入後成為便祕的機率是非耳穴介入組的0.002倍(p<0.001)，表示經由耳穴貼壓可以改善客觀便祕症狀；耳穴貼壓介入對心率變異改善成效結果顯示，LF方面，耳穴介入組於介入後比非耳穴介入組減少98.45（p=0.007），LF/HF方面，耳穴介入組於介入後比非耳穴介入組減少2.34（p=0.007）；表示經由耳穴貼壓可改善心率變異之交感神經及自律神經平衡指標。研究結果顯示，耳穴貼壓介入對於社區康復之家住民客觀便祕症狀、主觀便祕症狀、心率變異率具改善成效，故未來於實務面上，建議可於社區康復之家推廣耳穴貼壓衛教方案或教導社區康復之家住民耳穴按摩技巧。然而，由於研究樣本數較少，未來仍需要更多研究，以增加耳穴貼壓對改善康復之家住民便祕之實證證據。
Objective: To examine the efficacy of applying auricular acupressure (AA)
treatment at auricular points: Shenmen, Large intestine, Rectum, and Sanjiao on improving constipation among residents with Schizophrenia in community rehabilitation center.
Methods: One hundred subjects were recruited from community rehabilitation center in northern Taiwan. A cross over design is used for this study.The eligible participants were randomly assigned to experimental group I and experimental group II. Experimental group I received 8 weeks of auricular acupressure then 8 weeks of routine health care of constipation. Experimental group II received same interventions in reverse order (8 weeks of routine health care of constipation then 8 weeks of auricular acupressure). In both groups, any interventions were stopped for six weeks as residual effect wash-out period after 8 weeks intervention. Outcome measures include demographic variables, general health status and defecation condition. Subjective defecation condition included constipation related symptoms measurement (Patient Assessment of Constipation Symptoms). Objective defecation condition included frequency of defecation, the grade of Bristol Stool Form Scale and heart rate variability. Mean, standard deviation, frequency, percentage, t-test and chi-square test will be used to analyze the data. In addition, generalized estimating equations will be used to examine the effect of auricular acupressure on improving constipation.
Result: Our findings found that interventional group with completing 8-week auricular acupressure at Shenmen, Large intestine, Rectum, and Sanjiao significant improved subjective constipation related symptoms of abdominal symptom, rectal symptom, and stool symptom compared to non-interventional group with completing 8-week routine care(p<0.001). Moreover, interventional group had higher frequency of defecation than non-interventional group(p<0.001). And the probability of constipation in the intervention group after auricular acupressure was 0.002 times that of the non-intervention group (p<0.001). Besides, in terms of heart rate variability, non-interventional group has increased significantly in LF/HF(p<0.001). In comparison, interventional group has decreased significantly in LF(p=0.007) and LF/HF(p=0.007).
Conclusion: Auricular acupressure is an effective non-pharmacological method for improving subjective constipation related symptoms and objective frequency of defecation, stool consistency in residents in Community Rehabilitation Center. Regular performing auricular acupressure at auricular points of Shenmen, Large intestine, Rectum, and Sanjiao could be considered as alternative treatment approach for improve constipation in residents in Institutions for Psychiatric Rehabilitation. |
