xue wei an mo dui jie zhi chang ai shou shu hou chang gong neng hui hui yan jiu

Ph.D.BackgroundColorectal cancer (CRC) is the third most common cancer worldwide in 2018. After surgery treatments, gastrointestinal function is impaired among patients with CRC. Acupressure is a promising technique that utilises force to stimulate acupoints for improving gastrointestinal function.AimsThis study mainly aims to evaluate the effectiveness of acupressure and determine its potential clinical application to improve postoperative gastrointestinal function among patients undergoing CRC surgeries.MethodsThis study comprised three phases. Phase I was a systematic review to examine the effects of acupressure on the postoperative gastrointestinal function of patients undergoing abdominal surgeries from literature. The results of the systematic review were used to guide the development of an evidence-based protocol. Phase II was a small-scale pilot study that involved a randomised controlled trial (RCT, n=13) and a qualitative study (n=4) to assess the feasibility and acceptability of the protocol for a full-scale study. Phase III was the main study that adopted a RCT (n=112) and qualitative interviews of patients (n=12) and nurses (n=11). Adult patients (≥ 18 years old) who were scheduled to undergo CRC surgeries were recruited and randomised to receive acupressure or sham acupressure at the acupoint Stomach 36 (ST36, 足三裡) for five days after the operation. Primary outcomes included time of first passage of flatus and defecation and secondary outcomes included postoperative nausea and vomiting, bowel motility, abdominal distension and pain. The first passage of flatus and defecation were analysed using student t-test and regression analysis. Generalised estimating equation (GEE) models were used to compare the effects of acupressure on gastrointestinal symptoms at different time points.ResultsIn Phase I, the systematic review included nine studies and 1,191 participants. The meta-analysis results showed that acupressure significantly reduced the incidence of postoperative nausea (odds ratio, OR 0.56, 95% confidence interval, CI 0.44-0.72, P<0.01) and vomiting (OR 0.57, 95% CI 0.37-0.88, P=0.01) compared with the control. No severe side effects of acupressure were reported.In Phase II, the pilot study demonstrated the feasibility of the protocol in clinical setting and recommended the adoption of 10-dose acupressure in the main study. Additionally, the recruitment process of the patients was better than expected, with a refusal rate of 7.1% only. Acupressure was well accepted by the participants, as reflected from the qualitative data.In Phase III, the result of the multivariate regression analysis showed that acupressure significantly shortened the time interval of first flatus passage of the patients by 11.08 hours (95% CI -19.36 to -2.81) (P<0.01) with the effect size at 0.27. No significant influences of acupressure on the first passage of defecation were found. Furthermore, the GEE models showed that patients who received acupressure exhibited significantly improved bowel motility (effect size 0.21) and decreased abdominal distension (effect size -0.18) compared with the control. Additionally, the qualitative results provided supplementary information with five themes were generated, including acceptability, perceived effects of acupressure, suggestions for acupressure intervention, facilitators of clinical application, and barriers of clinical application. Generally, acupressure was well-accepted by patients and nurses, and no side effects were detected during the study. The procedure generally satisfied the patients, and some suggestions, including prolonging the duration of acupressure and adjusting force, were proposed. In the future, acupressure is expected to be applied in clinical settings considering several factors (i.e. support from management and doctors; knowledge and training; human resources; charge and implementer).ConclusionThis study demonstrated the feasibility and effectiveness of acupressure in clinical settings. Acupressure effectively shortened the time interval of the first flatus passage, improved bowel motility and reduced abdominal distension. Furthermore, acupressure was well-accepted by patients and nurses. Overall, the findings provide additional knowledge and evidence for the clinical implementation of acupressure to improve postoperative gastrointestinal function among patients undergoing CRC surgery.研究背景結直腸癌（colorectal cancer, CRC）是2018 年全球第三大常見癌症。手術治療後，結直腸癌患者常出現胃腸功能障礙。穴位按壓是一種利用力來刺激穴位的技術，它可以用來改善胃腸功能。研究目的本研究旨在評估穴位按壓對改善結直腸癌患者術後胃腸功能的有效性，並探究其在改善結直腸癌手術患者術後胃腸功能方面的潛在臨床應用。研究方法該研究包括三個階段。第一階段是一項系統評價，旨在確定以往文獻中穴位按壓對接受腹部手術患者術後胃腸功能的影響。第一階段的結果用於指導基於證據的研究計畫的開發。第二階段是一項小規模預試驗研究，採用隨機對照試驗（n = 13）和質性研究（n = 4）方法，以評估該方案在正式研究中的可行性和可接受性。第三階段是主要研究，採用隨機對照試驗（n = 112）和質性研究，其中包括患者（n = 12）和護士（n = 11）的質性訪談。招募計劃接受結直腸癌手術的成年患者（≥18 歲）並被隨機分配到接受足三裡穴位按壓組或安慰組，持續5 天。主要結果包括第一次排氣和排便的時間，次要結果包括術後噁心程度，嘔吐次數，腸鳴音次數，腹脹和疼痛的程度。使用獨立樣本t 檢驗和回歸分析比較兩組間在第一次排氣和排便時間的差異。廣義估計方程模型用於比較穴位按壓在不同時間點對胃腸道症狀的影響。研究結果在第一階段，系統評價共納入9 項研究和1,191 名參與者。薈萃分析結果顯示，穴位按壓顯著降低了術後噁心的發生 (odds ratio, OR 0.56,95% confidence interval, CI 0.44-0.72, P＜0.01) 和嘔吐的發生率 (OR 0.57,95% CI 0.37-0.88, P=0.01) 。文獻沒有報告穴位按壓的嚴重副作用。在第二階段，預試驗研究證明瞭該方案在臨床環境中的可行性，並建議在主要研究中採用10 次（一天兩次）的穴位按壓。此外，患者的招募過程比預期好，拒絕率僅為7.1%。定性數據表明，參與者很接受穴位按壓。在第三階段，多元回歸分析的結果顯示，穴位按壓顯著縮短了患者首次排氣時間11.08 小时 (95% CI -19.36 to -2.81) (P