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系統識別號 U0026-0812200911424816
論文名稱(中文) 呼吸鬆弛法對心臟手術後病患疼痛及心率變異之影響
論文名稱(英文) The Effects of Breathing Relaxation Therapy on Pain and Heart Rate Variability in Patients after Cardiac Surgery
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 93
學期 2
出版年 94
研究生(中文) 張淑君
研究生(英文) Shu-Chun Chang
學號 t2692102
學位類別 碩士
語文別 中文
論文頁數 102頁
口試委員 指導教授-顏妙芬
召集委員-邱艶芬
口試委員-陳清惠
中文關鍵字 疼痛  呼吸鬆弛法  心率變異 
英文關鍵字 heart rate variability  breathing relaxation therapy  pain 
學科別分類
中文摘要   本研究的目的在探討呼吸鬆弛法對心臟手術病人其疼痛及心率變異之成效。同時探討疼痛及心率變異的相關性。採類實驗性研究設計重複測量研究方法,選取南部某兩所醫學中心心臟外科病房,以立意取樣選取共15位心臟手術後病人參與,以隨機分配至實驗期及控制期。於術前一天接受呼吸鬆弛法訓練與練習,待病人手術後由加護單位轉入病房後,執行呼吸鬆弛法一天兩次,共連續執行三天,並以視覺類比量表測量疼痛程度及Biocom Heart Rhythm Scanner 測量心率變異進行前後測資料收集,其心率變異指標包括SDNN、LH、HF、Total Power。
  以paired t test及Wilcoxon Signed Ranks Test比較實驗期與控制期各次疼痛程度前後測改變量,除第二次(Z = -1.79, p > 0.05)外,皆達統計上顯著差異(p < .05)。心率變異SDNN在第二、四、五次;TP在第二、五次;LF在第一、二、四、五次;HF在第一、二、五次達到統計上顯著水準(p < .05)。另以廣義估計函數式(Generalized estimating equation, GEE)進行比較實驗期與控制期疼痛程度及心率變異重複測量期間前後測改變量及其受到時間因素的相關探討。在六次重複測量期間,β1估計係數檢定兩期變數,除TP外均達顯著差異(p < .05),β2估計係數檢定與時間變異數相關性,除疼痛程度外均未達顯著差異(p < .05),β3估計係數檢定交互作用,除疼痛程度及HF外均沒有交互作用,未達顯著差異(p < .05)。最後以無母數的Kendall等級相關來進行檢定疼痛及心率變異的相關性,發現在第五次呼吸鬆弛法介入後,疼痛程度與心率變異HF有顯著正相關(r = 0.36, p < .05)。心率變異TP與疼痛程度呈現顯著負相關(r = -0.40, p < .05)。
  由以上研究結果得知,對於胸骨切開後個案進行呼吸鬆弛法,可有效的減輕疼痛與增加副交感神經活性,是為一項值得學習及推廣在心臟手術後的措施。

英文摘要  The purpose of this study was to investigate the effects of breathing relaxation therapy for patients with cardiac surgery. The relationship between the degrees of pain and heart rate variability were also examined. The design of this study was crossover design with purposive sampling. Fifteen participants with cardiac surgeries were invited to participate. Participants entered into the sequence of experimental and control period, or control and experimental period randomly.
 The outcome indicators included the degrees of pain and heart rate variability. The degrees of pain were measured by visual analogue scale (VAS). The heart rate variability was measured by Biocom Heart Rhythm Scanner. The indexes included the standard deviation of the normal-to-normal interval (SDNN), total power (TP), low frequency power (LF), and high frequency power (HF).
 The data was analyzed by paired t test and Wilcoxon Signed Ranks test to compare pain levels and hart rate variability during six times each in experimental period and control period. Generalized estimating equation (GEE) was using to examine if the time would be a factor influencing the degrees of pain and heart rate variability. Finally, Kendall tests were used to examine the correlations on the degrees of pain and heart rate variability.
 The results of this study showed that the differences on the degrees of pain before and after the experimental period and control period were statistically significant (p < .05), except on the second time (p > .05). During six times of repeated measurement period using the GEE approach, β1 coefficient examined periodical variations, β2 coefficient examined the effect of the breathing relaxation technique along the time frame, both coefficients weren’t statistically significant (p > .05). β 3 estimation coefficient examined the interaction between the main effect and time, there were significant differences on indicators of degrees of pain, and HF (p < .05). However, there was no interaction between the main effect and time on the SDNN, LF, and TP. The degrees of pain in 5th time of breathing relaxation therapy had significantly positive correlation with HF (r = 0.36, p < .05), and had significant negative correlation with TP (r = -0.40, p < 0.05).
 This study provided information on the use of breathing relaxation technique for patients with cardiac surgery. This technique was proved to be effected on the reduction of the degrees of pain and stimulated the activities of parasympathetic nerve. The breathing relaxation exercise can be applied in the clinical setting with prudent implementation steps.

論文目次 論文目錄

中文摘要------------------------------------------------Ⅰ
英文摘要------------------------------------------------Ⅲ
誌謝----------------------------------------------------Ⅴ
論文目錄------------------------------------------------Ⅶ
表目錄--------------------------------------------------Ⅹ
圖目錄--------------------------------------------------XI
附錄----------------------------------------------------XI
附件----------------------------------------------------XI

目 錄
第一章 緒論---------------------------------------------1
第一節 研究問題的背景-----------------------------------1
第二節 研究動機與重要性---------------------------------3
第三節 研究目的-----------------------------------------5
第四節 研究問題-----------------------------------------5
第二章 文獻查證-----------------------------------------6
第一節 心臟手術後疼痛-----------------------------------6
第二節 呼吸鬆弛法--------------------------------------13
第三節 心率變異----------------------------------------21
第三章 研究方法與過程----------------------------------25
第一節 研究概念架構------------------------------------25
第二節 研究假設----------------------------------------27
第三節 名詞定義----------------------------------------28
第四節 研究對象與場所----------------------------------30
第五節 研究設計----------------------------------------32
第六節 研究工具----------------------------------------33
第七節 資料收集過程------------------------------------36
第八節 資料處理與統計分析方法--------------------------39
第九節 倫理考量----------------------------------------42
第四章 研究結果----------------------------------------43
第一節 研究對象之基本資料------------------------------43
第二節 接受胸骨切開術後病患疼痛程度及心率變異資料分析-------------------------------------------------------48
第三節 呼吸鬆弛法對改善胸骨切開術後疼痛程度及心率變異成效之探討-------------------------------------------------------49
第四節 胸骨切開術後病患疼痛程度及心率變異相關性討論-------------------------------------------------------57
第五章 討論--------------------------------------------58
第一節 呼吸鬆弛法對改善心臟手術後病患疼痛之成效-------------------------------------------------------58
第二節 呼吸鬆弛法對改善心臟手術後病患心率變異之成效-------------------------------------------------------60
第三節 胸骨切開術後病患疼痛程度及心率變異之相關性-------------------------------------------------------63
第四節 研究過程之探討----------------------------------65
第五節 研究分析方法之探討------------------------------67
第六章 結論--------------------------------------------70
第一節 研究結果之應用、建議與限制----------------------70
參考資料-----------------------------------------------72
一、中文部份-------------------------------------------72
二、英文部份-------------------------------------------76
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