[[alternative]]The Effects Of Abdomen Massage For Reducing Cancer Patients’ Malignant Ascites And Its Associated Symptoms

[[abstract]]約有15-50%的癌末病人有惡性腹水，進而引起腹水叢集症候群，增加末期病患的不適與照護上的挑戰。本研究目的為測試非侵入性的腹部淋巴按摩對改善腹水及腹水叢集症候群之成效。研究採類實驗型設計，於2010年08月至2011年08月間於北部某醫院的胃腸肝膽科病房和腫瘤科病房，以方便取樣，招募符合收案之惡性腹水癌症病人共80位，並以簡單隨機分派40位病人為控制組及40位為實驗組，實驗組病人接受連續3天、一天2次、每次10分鐘的腹部按摩及5分鐘雙側腰部按摩，控制組病人未接受任與本研究相關之措施，並於第1天至第4天分別測量每位參與病人惡性腹水叢集症狀之嚴重程度，包括疼痛、疲憊、噁心、憂鬱、焦慮、嗜睡、食慾、舒適感、呼吸喘、腹脹和活動力，以及腹圍和體重。研究工具包括Edmonton Symptom Assessment System-Ascites Modification (ESAS:AM)評估量表，測量腹圍之皮尺和體重計。以平均數、標準差、百分比來描述研究對象之人口學變項、疾病特性、腹水症狀、腹圍及體重；以Chi-Square和t-test來進行實驗組與控制組在人口學變項、疾病特性、前測之腹水症狀、腹圍及體重同質性之組間比較，另以概似估計方程式 (Generalized Estimating Equations,GEE)進行腹水叢集症狀、腹圍和體重之組別與時間交互作用之檢視，以推論介入措施之成效。研究結果顯示3天之腹部按摩介入措施能有效改善腹水叢集症候群，在組別與時間的交互作用有統計上的顯著意義(Wald X2 = 4187.016,p <0.001***)，實驗組第4天比上控制組第0天的β為-0.305(SE = 0.0049, p<0.001***)，在11個叢集症狀中，腹部按摩介入措施能有效改善疼痛、疲憊、憂鬱、焦慮、嗜睡、食慾不佳、不舒適感、呼吸喘和腹脹，但對噁心與活動限制則未能有效改善，另外體重(Wald X2 = 2827.249, p<0.001***)在組別與時間交互作用上也有顯著差異。研究結果顯示非侵入性之腹部按摩可以有效改善末期癌症病人之惡性腹水與相關之叢集症狀，護理人員藉由腹部按摩改善腹水及其相關症候且改善病人生活品質，可考慮此腹部按摩介入措施改善惡性腹水相關症候，可被擴大應用於接受安寧療護之病人以增進其舒適。[[abstract]]Patients with advanced cancer often experience a number of distressing symptoms that lead to impacting patients’ quality of life. Approximately 15-50% will develop malignant ascites and ascites-related symptom cluster, including distention, pain, decreased in activity, fatigue, dyspnea, loss of appetite, nausea, and hypoactive bowel movement. These symptoms creat great challenge for health professionals to provide care for end stage cancer patients. Thus, the purpose of this study is to examine the efficacy of abdominal massage for improving ascites-related symptom cluster. This study is a quaxi-experimental design. A convenient sample of 80 cancer patetinst with ascites was recruited from GI and oncology units in a northern medical center and then randomly assigned to the experimental (receiving three-day abdominal massage) or control (receiving social attention) group. Data were collected from Aug 2010 to Aug 2011. Ascites-related symptom cluster, body weight, and abdomen girth of paunch were measured at ervery morning for 4 days by using the Edmonton Symptom Assessment System-Ascites Modification (ESAS:AM) questionnaire, a body weight scale, and a measuring tape. Descriptive statistics were used to decribe participants’ demographics, disease profile, and outcome variables.Chi-Square, t-test, and Generalized Estimating Equations were used for examining group difference in terms of ascites-related symptom cluster, body weight and abdomen Girth of paunch. Results of GEE showed that there was a significant group by time interaction in ascites-related symptom cluster (Wald X2 = 4187.016, p <0.001***), and body weight(Wald X2 = 2827.249, p