熱敷與伸展運動對氣體視網膜術後趴臥病人肩頸疼痛與困擾程度緩解之成效

Exploring the Effectiveness of Heating Pad and Stretching Exercises for Relieving Shoulder and Neck Pain Caused by Prone Position After Pneumatic Retinopexy

10.6142/VGHN.202003_37(1).0001

朱紋瑩(Wurn-Yirng Ju)；周成蕙(Cheng-Hui Chou)；陳美娟(Mei-Chuan Chen)；戴綾儀(Ling-Yi Tai)；葉燕芬(Yann-Fen Yeh)

熱敷 ； 伸展運動 ； 氣體視網膜固定術 ； 趴臥病人 ； 肩頸疼痛 ； heating pad ； stretching exercise ； pneumatic retinopexy ； prone position ； shoulder and neck pain

榮總護理

37卷1期（2020 / 03 / 01）

2 - 13

繁體中文

氣體視網膜固定術是目前治療視網膜剝離的標準手術。為增加手術成功率，減少白內障術後併發症，術後須依醫囑24小時持續趴臥姿勢，因而造成肩頸疼痛。本研究為探討氣體視網膜固定術後趴臥病人接受熱敷與伸展運動緩解肩頸疼痛與困擾程度之比較。採類實驗性研究設計，於2017年9月至12月招募北部某醫學中心眼科病房接受氣體視網膜固定術後趴臥病人。參加者採方便選樣分派為實驗組與對照組，兩組於手術返回病房後都接受相關護理指導，實驗組接受熱敷與伸展運動（含頸部前伸展、拉展手臂、肩膀轉圈、雙臂背後拉展及肩關節外展及前屈）。兩組於術後當天及術後第1天、第4天進行三次資料收集。肩頸疼痛程度與困擾程度測量工具為台灣版－簡易疼痛量表（BPI-T）。本研究納入統計分析共68人，包括實驗組33人（平均56.31歲，男性54.5%）及對照組35人（平均60.77歲，男性48.6%）。經GEE分析，五個效果指標，肩頸疼痛程度未達顯著差異；情緒困擾程度改善最明顯，於術後第一天即達顯著差異；一般活動困擾程度、行走能力困擾程度與睡眠困擾程度，皆於術後第四天達顯著差異。本研究結果指出接受熱敷與伸展運動病人，可改善其趴臥期間之困擾程度。此結果可提供護理實務執業者對氣體視網膜固定術後趴臥病人臨床照護之參考。

Currently, pneumatic retinopexy is the standard procedure for treating retinal detachment. Studies have demonstrated that postoperative 24-h position facilitates the success of pneumatic retinopexy and reduces the incidence of posterior subcapsular cataract. However, maintaining the prone position for a long time can easily lead to neck and shoulder pain. The effectiveness of stretching exercises in relieving pain in the neck and shoulder of patients after pneumatic retinopexy was studied using a quasi-experimental approach. Post pneumatic retinopexy patients were recruited in Taipei Taiwan from September 2017 to May 2018. The control group received typical nursing care, whereas the experiment group was provided with heating pads and subjected to a stretch exercise program. The study outcomes were measured using brief pain inventory (BPUT)- Taiwanese version. Data were collected at baseline and days 1 and 4 post operation. A total of 68 patients participated in this study, with 33 patients in the stretching exercise group (a mean age of 56.31, 54.5% men) and 35 in the control group (a mean age of 60.77, 48.6% men). The results of the generalized estimating equation model showed no significant difference in shoulder and neck pain between the two groups. However, significant difference was observed in emotional distress since day 1 in the experiment group. Significant differences were observed in the distress experienced when performing general activity, walking discomfort, and sleep disturbance on day 4 in the experiment group. The results of this study can be used as a reference for nursing practitioners regarding the care of pneumatic retinopexy patients.

1. 張麗春,吳佩昌,玉珍,陳敏麗,廖梨伶(2016)。台灣校園近視防治軌跡。台灣公共衛生雜誌，35(1)，17-30。
   連結：
2. Andersen, C. H.,Andersen, L. L.,Pedersen, M. T.,Mortensen, P.,Karstad, K.,Mortensen, O. S.,Sjogaard, G.(2013).Dose-response of strengthening exercise for treatment of severe neck pain in women.The Journal of Strength & Conditioning Research,27(12),3322-3328.
3. Apfelbaum, J. L.,Chen, C.,Mehta, S. S.,Gan, T. J.(2003).Postoperative pain experience: Results from a national survey suggest postope rative pain continues to be undermanaged.Anesthesia & Analgesia,97(2),534-540.
4. Bokarius, A. V.,Bokarius, V.(2010).Evidence-based review of manual therapy efficacy in treatment of chronic musculoskeletal pain.Pain Practice,10(5),451-458.
5. Buckley, H.(2000).Students’ Corner : Nurse management o f po st -ope rative pain.Contemporary Nurse,9(2),148-154.
6. dell'Omo, R.,Semeraro, F.,Guerra, G.,Verolino, M.,Cinelli, M.,Montagnani, S.,Costagliola, C.(2013).Short-time prone posturing is well-tolerated and reduces the rate of unintentional retinal displacement in elderly patients operated on for retinal detachment.BioMed Central Surgery,13(2),S55.
7. Donovan, M.,Dillon, P.,McGuire, L.(1987).Incidence and characteristics pain in a sample of medical-surgical inpatients.Pain,30(1),69-78.
8. Eltayeb, S. M.,Staal, J. B.,Hassan, A. A.,Awad, S. S.,de Bie, R. A.(2008).Complaints of the arm, neck and shoulder among computer office workers in Sudan: A prevalence study with validation of an Arabic risk factors questionnaire.Environmental Health,7(1),33.
9. Ger, L. P.,Ho, S. T.,Sun, W. Z.,Wang, M. S.,Cleeland, C. S.(1999).Validation of the brief pain inventory in a Taiwanese Population.Journal of Pain and symptom Management,18(5),316-322.
10. Holden, B.,Sankaridurg, P.,Smith, E.,Aller, T.,Jong, M.,He, M.(2014).Myopia, an underrated global challenge to vision: Where the current data takes us on myopia control.Eye,28(2),142-146.
11. Kayne, H. L.,Heeren, T. C.(1990).Basic and clinical biostatistics.New England Journal of Medicine,323(18),1287.
12. Lin, L. Y.,Wang, R. H.(2005).Abdominal surgery, pain and anxiety: Preoperative nursing intervention.Journal of Advanced Nursing,51(3),252-260.
13. Murphy, M.,Nevill, A.,Neville, C.,Biddle, S.,Hardman, A.(2002).Accumulating brisk walking for fitness, cardiovascular risk, and psychological health.Medicine & Science in sport & Exercise,34(9),1468-1474.
14. Pretty, J.,Peacock, J.,Sellens, M.,Griffen, M.(2005).The mental and physical health out comes of green exercise.International Journal of Environmental Health Research,15(5),319-337.
15. Schwartz, S. G.,F, H. W., Jr,Lee, W. H.,Wang, X.(2014).Tamponade in surgery for retinal detachment associated with proliferative Vitreoretinopathy.Cochrane Database of Systematic Review,2,1-41.
16. Tan, H. S.,Oberstein, S. Y. L.,Mura, M.,Bijl, H. M.(2013).Air versus gas tamponade in retinal detachment surgery.British Journal of Ophthalmology,97(1),80-82.
17. 甘其銓,翁愃穎,蔡一如,黃月珠(2013)。溫泉浸泡應用緩解肩頸痠之效益研究。嘉南學報，39，150-159。
18. 何怡德,洪紫齡,王鐘慶,王映權,江昇達,陳韋良,劉紹興(2016)。某地區醫院肩頸疼痛與生活型態危險因子相關性調查。中華職業醫學雜誌，23(1)，21-34。
19. 明金蓮,洪曉佩(2011)。急性疼痛評估與症狀護理。源遠護理，5(1)，11-16。
20. 林頌凱,曾愷平,張煥禎(2007)。肌筋膜疼痛症候群。基礎醫學，22(4)，140-146。
21. 莊宗憲(2015)。視網膜剝離簡介。中華民國內膜異位症婦女協會會刊，22(5&6)，6-8。
22. 陳世真,程景煜(2009)。台灣地區視網膜病變的盛行和衝擊─相關文獻的回顧。中華民國眼科醫學會雜誌，48(3)，237-244。
23. 黃正賢(2013)。年齡相關性黃斑部病變致病機轉與流行病學。台灣醫學，17(3)，260-266。
24. 楊長豪,方怡謨,游建章,王律鈞(2009)。常見之玻璃體視網膜疾病。台灣醫學，13(4)，361-371。
25. 楊政峰,卓瓊玉,陳宜紋(2011)。探討不同程度骨酪肌肉系統症狀電腦族在從事不同速度電腦作業時之姿勢控制之比較：前趨研究。物理治療，37(3)，245-251。
26. 葉燕芬,廖秋月,陳世真,黃秀芬(2011)。網膜氣體固定術後病人應用創新趴床之成效。榮總護理，28(4)，354-362。
27. 葛魯蘋(2004)。台灣版簡易疼痛量表之簡介。疼痛通訊，45，8-14。
28. 劉波兒,林麗君,江晏榆,曾佳瑩,簡瑜秀,林蓉秀(2008)。精油按摩應用於頸肩疼痛成效之初探。領導護理雜誌，9(2)，18-30。
29. 劉寬鎔,梁怡珈,陳慕師(2013)。老年性黃斑部病變之治療。台灣醫學，17(3)，267-279。