穴位按壓是否能緩解透析病人之尿毒性搔癢症Whether acupressure can relieve uremia pruritus in hemodialysis patients?

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2019-05-06 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

呂婧希* 林月娥* 韓慧美

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

腎臟與高血壓 Nephrology and Hypertension

科別

  • 腎臟及泌尿護理 Renal and Urology Nursing

中文關鍵詞

透析、尿毒性搔癢症、穴位按壓

英文關鍵詞

hemodialysis uremia pruritus acupressure

機構名稱

長庚醫療財團法人林口長庚紀念醫院

申請單位

護理部

中文摘要

形成臨床提問:
尿毒性搔癢症不僅會影響接受血液透析病人生活品質,容易引發續發性皮膚感染,而且也有研究顯示其與血液透析病人的死亡率呈正相關。傳統治療對於尿毒性搔癢症的緩解成效有限,部分研究指出穴位按壓可有效緩解尿毒性搔癢症。本文目的旨在透過實證實務方式來探討穴位按壓對緩解血液透析病人尿毒性搔癢症之成效,冀能提供作為照顧此類病人實證依據的參考。
文獻搜尋的方法與分析:
以PICO及MeSH term建立關鍵字及同義字,配合布林邏輯原則,搜尋Cochrane library、Embase、PubMed及CEPS華藝中文電子期刊等資料庫,共搜尋出93篇文獻,其中選定1篇隨機對照試驗研究及1篇系統性文獻統合分析進行評析。
文獻的品質評讀:
所評讀的2篇文獻是依Oxford 2011證據等級分為Level 1及Level 2,並以CASP對其效度、重要性及應用性進行評析。2篇文獻研究目的皆在探討接受血液透析病人在接受穴位按壓後其尿毒性搔癢症的緩解成效,並以搔癢視覺模擬量表(VAS),測量受試者接受介入措施前後的搔癢度,且兩篇都有良好的研究設計,在重要性的評讀部分,隨機對照試驗研究結果顯示每週三次,進行4週的按摩穴位按壓或經皮穴位電刺激對於尿毒性搔癢症的緩解顯著優於常規照護(p<.001);系統性文獻回顧之統合分析結果顯示穴位按壓或針灸措施在緩解尿毒性搔癢症的成效上具顯著差異(綜合平均數差異=-1.99;95% CI=-2.544至-1.445),另發現穴位按壓若合併抗組織胺類藥物使用時,緩解尿毒性搔癢症的效果顯著優於常規照護。在應用性部分,由於穴位按壓目前無明顯不良反應、不具侵入性,亦可減低抗組織胺藥物的使用量,其利益大於傷害。
結論與建議:
綜整評讀結果發現穴位按壓緩解尿毒性搔癢症的效果顯著優於常規照護,建議可將文獻證據轉譯應用於尿毒性搔癢症的輔助治療上。

英文摘要

Ask an answerable question (PICO):
Uremia pruritus could affect the quality of life of hemodialysis (HD) patients and causes secondary skin infections. Studies have also confirmed that it is positively correlated with the mortality of HD patients. However, the effectiveness of traditional treatment on uremia pruritus is limited, and studies have proved that acupressure can effectively relieve uremia pruritus. The purpose of this study is to apply the evidence-based practice method to explore the effectiveness of acupressure on alleviating uremia pruritus in HD patients. The results can be used as a reference for caring for such patients.
The Method and Analysis of Literature Review:
This study established keywords and synonyms with PICO and MeSH term, and then cooperated with Boolean logic principles to systematically search for the research evidence. Databases such as Cochrane library, Embase, PubMed and CEPS were searched for literatures. A total of 93 literatures that matched the search criteria were then extracted. One randomized controlled trial study and one systematic review with meta analysis were selected for critical appraisal of the validity, relevance, and applicability of the research evidence.
Critical Appraisal:
The two studies reviewed were identified as Level 1and Level 2 according to the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. The validity, importance and practicability were critically appraised with the use of CASP checklists. The purpose of both studies was to investigate the relief of uremia pruritus in dialysis patients after receiving acupressure. The VAS scale was used to measure the degree of pruritus before and after intervention. Both studies revealed good validities. With the aspect of importance, the RCT study showed that applying the acupressure or transcutaneous electrical acupoint stimulation 3 times per week for 4 week duration had significantly better effects (p<.05) than routine care in uremia pruritus relief. The result of SR showed that acupuncture or acupressure was effective in treatment of uremic pruritus (pooled mean difference= -1.994; 95% confidence interval, -2.544 to -1.445). It was also found that acupressure combined with other drugs had better effect in uremia pruritus relief than routine care. For the aspect of applicability, acupressure is a non-invasive approach with little adverse reaction. Its usage can also reduce the dosage use of antihistamine. Thus, the benefits of acupressure are worth the harms and costs.
Conclusions and Recommendations:
According to the critical appraisal results, acupressure had better effect in uremia pruritus relief than routine care. Therefore the use of acupressure on the relief of uremia pruritus for HD patients is recommended to be translated into clinical practice.