第四章 結論建議
第三節 限制
一、本研究針對收案文章的研究方法品質，僅以 Jadad 分數表做評估，未針 對其文章在研究設計、收案條件加以評論與探討，可能影響研究方法
品質評論的深、廣度。
二、系統性文獻回顧法，重視文章收集完整性與客觀性，適合該領域專家 整合研究小組（team work），進行完整文章搜尋及整合工作。Counsell
（1998）認為不設語言限制、熟習各資料庫檢索技巧、逐本翻閱（manual searching）期刊、書籍和相關的會議記錄、訪問專家以及從文後所列的 參考資料等方式都是找尋文章的重要來源。Poctor, Smith, Farqular, &
Stone(2004)也建議與各篇文章中的作者聯繫，將可獲得更深入的訊息。
本研究在考量資料收集的可行性及時間的限制下，僅收集MEDLINE、
中國期刊全文資料庫、中華民國期刊論文索引以及台灣博碩士論文資 訊網四個資料庫，並限制以中、英文呈現的文章，完整性也許較欠缺。
三、由於具實證基礎的穴位按摩文章不足，且照護領域包含 7 個主要症狀 19 個次症狀，故無法以統合分析（meta-analysis）評論穴位按摩照護成 效。
參考文獻
年7 月 5 日取自 http:www.ccmp.gov.tw/index-c/1.htm行政院衛生署（2003）．92年衛生統計資訊網：醫療設施、醫事人力現況及醫療服務．
2005 年 6 月 8 日取自 http://www.doh.gov.tw/statistic/index.htm 余宗男（1998）．經穴點壓療法（10-30 頁）．北京：中國中醫藥。
李智貴、陳恆順（1995）．統合分析（Meta-Analysis）之簡介．當代醫學，22（2），167-172。
李亞杰、陳秀彥（1996）．針刺治療痛經體會．針灸臨床雜誌，12（4），51。
周建偉、趙菁菁、張顏（2004）．近 20 年來針灸推拿治療椎動脈型頸椎病臨床研究的實
中醫藥委員會編印。
郭英調（1998）．整合分析（meta-analysis）簡介．院內感染控制雜誌，8（2），469-472.
郭英調（2005，10 月）．實證醫學簡介．於中醫藥委員會主辦，中醫藥實證醫學發展策
略研討會．台中：中國醫藥大學。
莊美華（2001）．穴位點指壓對改善痛經之成效．未發表的碩士論文，台北：國立陽明
大學臨床護理研究所。
陳惠敏、陳彰惠（2003）．穴位指壓在婦女健康上的應用．長庚護理，14（4）379-385。
傅余坤（1996）‧試論推拿治療中的經穴疲勞現象及預防‧按摩與導引，（6），1-2。
熱的對比觀察．中國中醫基礎醫學雜誌，7（6），38-40。
龐俊（1994）．指壓法治療劇腹痛．江蘇中醫，15（10）30-31。
英文資料
Beal, M. W.(2000). Acupuncture and oriental body work: Traditional and biomedical concepts in holistic care: History and basic concept. Holistic Nursing Practice, 14(3), 69-78.
Bertalanffy, P., Hoerauf, K., Fleischhackl, R., Strasser, H., Wicke, F., Greher, M., Gustorff, B.,
& Kober, A. (2003). Korean hand acupressure for motion sickness in prehospital trauma care: A prospective, randomized, double-blind trial in a geriatric population. Anesth Analg, (98), 220-223.
Boehler, M., Mitterschiffthaler, G., & Schlager, A. (2002). Korean hand acupressure reduces postoperative nausea and vomiting after gynecological laparoscopic surgery. Anesth
Chen, L. L., Hsu, S. F., Wang, M. H., Chen, C. L., Lin, Y. D., & Lai, J. S. (2003). Use of acupressure to improve gastrointestinal motility in women after transabdominal hysterectomy. The American Journal of Chinese Medicine, 31(5), 781-791.
Chu, Y. C., Lin, S. M., Hsieh, Y. C., Peng, G. C., Lin, Y. H., Tsai, S K., & Lee, T. Y.(1998).
Effect of BL-10(Tianzhu), BL-11(Dazhu), and GB-34(Yanglinquan) acuplaster for prevention of vomiting after strabismus surgery in children. Acta Anaesthesiologica Sinica, 36(1), 11-16.
Chung, U. L., Hung, L. C., Kuo, S. C., & Huang, C. L. (2003). Effects of LI4 and BL67 acupressure on labor pain and uterine contractions in the first stage of labor. Journal of Nursing Research, 11(4), 251-260.
Counsell, C. (1998). Formulating questions and locating primary studies for inclusion in systematic reviews. In Mulrow, C. D.,& Cook, D. J. (Ed.), Systematic reviews(pp.5-12).
Maryland: American college of physicians.67-79.
Cook, D. J., Mulrow, C. D., & Brian Haynes, R.(1998). Synthesis of best evidence for clinical decisions. In Mulrow, C. D.,& Cook, D. J. (Ed.), Systematic reviews(pp.5-12). Maryland:
American college of physicians.
Davidson, P., Hancock, K., Leung, D., Ang, E., Chang, E., Thomposon, D.R., & Daly, J.
(2003). Traditional Chinese medicine and heart: What does western medicine and nursing science know about it? European Journal of Cardiovascular Nursing, 2, 171-181.
Dibble, S. L., Chapman, J., Mack, K. A., & Shin, A-S. (2000). Acupressure for nausea:
Results of a pilot study. ONF, 27(1), 41-47.
Ernst, E. (2000). Prevalence of use of complementary/alternative medicine: A systrmatic review. Bulletin of the World Health Organization, 78(2), 252-257.
Ezzo, J., Vickers, A., Richardson, M. A., Allen, C., Dibble, S. L., Lao, I. L., Pearl, M., Ramirez, G., Roscoe, J. A., Shen, J., Shivnan, J., Streitberger, K., Treish, I., & Zhang, G.
(2005). Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting.
Journal of Clinical Oncology, 23(28), 7188-7198.
Freeman, L. W. (2001). Massage therapy. In Freeman, L. W. & Lawlis, G. F., Complementary
& alternative medicine a research: Based approach (pp.361-385). St. Louis, MO:
Mosby.
Hsieh, L. L-C., Kuo, C. H., Yen, M. F. & Chen, T. H-H. (2004). A randomized controlled clinical trial for low back pain treated by acupressure and physical therapy. Preventive Medicine, 39(1), 168-176.
Complementary Therapies in Medicine, 13(1), 11-15.
Jewell D. (2002). Nausea and vomiting in early pregnancy. Clinical Evidence. (7), 1277-1283.
Klein, A.A., Djaiani, G., Karski, J., Carroll, J., Karkouti, K., McCluskey, S., Ponawala, H., Shayan, C., Fedorko, L., & Cheng, D.(2004).Acupressure wristbands for the prevention of postoperative nausea and vomiting in adult undergoing cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia, 18(1), 68-71.
Kober, A., Scheck, T., Greher, M., Lieba, F., Fleischhackl, R., Randunsky, F., & Hoerauf, K.
(2002). Prehospital analgesia with acupressure in victims of minor trauma: A prospective, randomized, double-blinded trial. Anesthesia analog , 95, 723-727.
Linde, K., Vickers, A., Hondras, M., Riet, Gt., Thormahlen, J., Berman, B., & Melchart, D.
(2001). Systematic reviews of complementary therapies-an annotated bibliography. Part 1: Acupuncture. BMC Complementary and Alternative Medicine, 1(3), 1472-1481.
Moher, D. Jadad, A. R., & Tugwell. P. ( 1996). Assessing the quality of randomized controlled trials. Current issues and future directions. Int J Technol Assess Health Care. 12(2), 195-208.
Mulrow, C. D., Cook, D. J., & Davidoff, F.(1998). Systematic review: Critical links in the great chain of evidence. In Mulrow, C. D.,& Cook, D. J. (Ed.), Systematic
reviews(pp.1-4). Maryland: American college of physicians.
NIN Consensus Development Panel on Acupuncture.(1998). NIH Consensus Conference : Acupuncture. JAMA, 280(17), 1518-1524.
Pan, C. X., Morrison, R. S., Ness, J., Fugh-Berman, A., & Leipzig, R. M. (2000).
Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: A systematic review. Journal of pain and symptom management, 20(5), 374-387.
Poctor, M. L., Smith, C. A., Farqular, C. M. & Stone, R. W.(2004). Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database of Systemic Review. 2,2004.
Roscoe, J. A., & Matteson, S. E. (2002). Acupressure and acustimulation bands for control of nausea: A brief review. American Journal of Obstetrics & Gynecology, 186(5), S244-247.
Rowbotham, D. J. (2005). Recent advances in the non-pharmacological management of postoperative nausea and vomiting. British Journal of Anaesthesia, 95(1), 77-81.
Sakurai, M., Suleman, M., Morioka, N., Akca, O. & Sessler, D. I. (2003). Minute sphere
analog , 96, 493-497.
Shin, Y. H., Kim, T. I., Shin, M. S., & Juon, H. S. (2004). Effect of acupressure on nausea and vomiting during chemotherapy cycle for Korean postoperative stomach cancer patient.
Cancer Nursing, 27(4), 267-274.
Smyth, R. L. (2002). Systematic review : What are they and how can they be used?. In J. V.
Craig, R. L. Smyth, & S. Mullally (Eds.), The evidence-based practice manual for nurses(pp. 164-183). New York :Churchill Livingstone.
Sok, S. R., Erlen, J. A., & Kim, K.B. (2003). Effects of acupuncture therapy on insomnia.
Journal of Advanced Nursing, 44(4), 375-384.
Steel, N. M., French, J., Gather-Boyles, J., Newman, S. ＆ Leclaire, S. (2001). Effect of acupressure by sea-bands on nausea and vomiting of pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing , 30(1), 61-70.
Stone, P.W. (2002). What is a systematic review? Applied Nursing Research, 15(1), 52-53.
Taylor, D., Miaskowski, C. & Kohn, J. (2002). A randomized clinical trial of effectiveness of an acupressure device (Relief Brief) for managing symptoms of dysmenorrheal. The Journal of Alternative and Complementary Medicine, 8(3), 357-370.
Tsay, S. L. (2004). Acupressure and fatigue in patients with patients with end-stage renal disease-a randomized controlled trial. International Journal of Nursing Studies 41, 99-106.
Tsay, S. L., Cho, Y. C. & Chen, M. L. (2004). Acupressure and transcutaneous electrical acupoint stimulation in improving fatigue, sleep quality and depression in hemodialysis patients. The American Journal of Chinese Medicine, 32(3), 407-416
Tsay, S. L., Rong, J. R., & Lin, P. F. (2003). Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease. Journal of Advanced Nursing 42(2), 134-142.
WHO.(2003,may).Traditional Medicine.r etrieved June 5, 2005, from://www.who.int/mediacentre/factsheets/fs134/en/print.htm
Xue, C. C., English, R., Zhang, J.J., Costa, C.D., & Li, C. G.. (2002). Effect of acupuncture in the treatment of seasonal allergic rhinitis : A randomized controlled clinical trial. The American Journal of Chinese Medicine, 30(1), 1-11.
附錄一 穴位按摩力度、劑量與方向
附錄二、研究工具（穴位按摩登錄表）
附錄三 專家效度檢定名單
專家姓名 所屬單位及職稱
高宗桂 大仁科技大學 護理系 副教授 暨
馬光中醫診所 副院長
陳麗麗 中國醫藥大學 護理系 講師
馬淑清 奇美醫學中心 護理部 副主任
杜惠娟 中國醫藥大學附設醫院 中醫門診部 護理長
附錄四 研究樣本（68 篇穴位按摩文章）
編號 樣本來源
#1 Dibble SL. Chapman J. Mack KA. Shih AS. (2000). Acupressure for nausea: results of a pilot study. Oncology Nursing Forum, 27(1), 41-47.
#2 Shin YH. Kim TI. Shin MS. Juon HS. (2004). Effect of acupressure on nausea and vomiting during chemotherapy cycle for Korean postoperative stomach cancer patients. Cancer Nursing, 27(4), 267-274.
#3 Ming JL. Kuo BI. Lin JG. Lin LC. (2002). The efficacy of acupressure to prevent nausea and vomiting in post-operative patients. Journal of Advanced Nursing, 39(4), 343-351.
#4 楊玉梅（1999）．穴位按摩防治子宮切除後噁心嘔吐．前衛醫藥雜誌，16（2），
111。
#5 Dundee JW., Sourial FB., Ghaly RG. Bell PF. (1988). P6 acupressure reduces morning sickness. Journal of the Royal Society of Medicine, 81(8), 456-457.
#6 Belluomini J., Litt RC., Lee KA., Katz M. (1994). Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstetrics &
Gynecology, 84(2), 245-248.
#7 Habek D., Barbir A., Habek JC., Janculiak D., Bobic-Vukovic M. (2004). Success of acupuncture and acupressure of the Pc 6 acupoint in the treatment of
hyperemesis gravidarum. Forschende Komplementarmedizin und Klassische Naturheilkunde, 11(1), 20-23.
#8 Markose MT., Ramanathan K., Vijayakumar J. (2004). Reduction of nausea,
vomiting, and dry retches with P6 acupressure during pregnancy. International Journal of Gynaecology & Obstetrics, 85(2), 168-169.
#9 Hu S., Stritzel R., Chandler A., Stern RM. (1995). P6 acupressure reduces symptoms of vection-induced motion sickness. Aviation Space & Environmental Medicine, 66(7), 631-634.
#10 Lu DP., Lu GP., Reed JF 3rd. (2000). Acupuncture/acupressure to treat gagging dental patients: a clinical study of anti-gagging effects. General Dentistry, 48(4), 446-452.
#16 唐有華、吳先平、陳浩銘（2004）．指壓少商穴對小兒氣管拔管後喉痙攣的防 治作用．現代中西醫結合雜誌，13（14），1845-1846。
#17 吳先平、陳浩銘（2000）．指壓療法防治小兒氣管拔管後喉痙攣的臨床觀察．
中華實用中西醫雜誌，13（24），2585-2586。
#18 廖木蘭（2005）．指壓合屏氣法治療呃逆療效觀察．廣西中醫藥，28（1），35。
#19 靳寶霞、王開新、任愛敏（2003）．指壓攢竹穴治療腫瘤病人呃逆效果觀察．
護理學雜誌，18（4），315。
#20 Chen HM., Chen CH. (2004). Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. Journal of Advanced Nursing, 48(4), 380-387.
#21 紀麗梅、徐南麗、邱慧洳、蕭正光（2004）．穴位指壓對緩解原發性經痛成效之
探討．慈濟護理雜誌，3（4），29-37。
#22 莊美華（2001）．穴位點指壓對改善痛經之成效．未發表的碩士論文，台北：
國立陽明大學臨床護理研究所。
#23 Pouresmail Z. (2002) Ibrahimzadeh R. Effects of acupressure and ibuprofen on the severity of primary dysmenorrhea. Journal of Traditional Chinese Medicine, 22(3), 205-210.
#24 Lee MK., Chang SB. Kang DH. (2004). Effects of SP6 acupressure on labor pain and length of delivery time in women during labor. Journal of Alternative &
Complementary Medicine, 10(6), 959-965.
#25 Chung UL., Hung LC., Kuo SC., Huang CL. (2003) Effects of LI4 and BL 67 acupressure on labor pain and uterine contractions in the first stage of labor.
Journal of Nursing Research, 11(4), 251-260.
#26 李美德、方輝榮、賈幼明、李艷冰、顧文莉（2003）．指壓穴位減輕分娩陣痛
及縮短產程的效果觀察．實用護理雜誌，19（9），26-27。
#27 廖碧珍、周勤（2003）．穴位按摩應用於分娩鎮痛的研究．重慶醫科大學學報，
28（4）541-543。
28 Kober A., Scheck T., Greher M. Lieba F., Fleischhackl R., Fleischhackl S., Randunsky F., Hoerauf K. (2002) Prehospital analgesia with acupressure in victims of minor trauma: a prospective, randomized, double-blinded trial.
Anesthesia & Analgesia, 95(3), 723-727.
#29 Felhendler D., Lisander B. (1996) Pressure on acupoints decreases postoperative pain. Clinical Journal of Pain, 12(4), 326-329.
#30
#35 Cho YC., Tsay SL. (2004). The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease. Journal of Nursing Research, 12(1), 51-59.
#36 Tsay SL. (2004). Acupressure and fatigue in patients with end-stage renal disease-a randomized controlled trial. International Journal of Nursing Studies, 41(1), 99-106.
#37 Tsay SL., Cho YC., Chen ML. (2004). Acupressure and Transcutaneous Electrical Acupoint Stimulation in improving fatigue, sleep quality and depression in hemodialysis patients. American Journal of Chinese Medicine, 32(3), 407-416.
#38 Tsay SL., Rong JR., Lin PF. (2003). Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease. Journal of Advanced Nursing, 42(2), 134-142.
#39 施玉燕（2003）．穴位指壓對末期腎疾病患者之皮膚搔癢、睡眠品質、憂鬱及
生活品質之成效探討．未發表的碩士論文，台北：國立台北護理學院護 理研究所。
#40 Chen ML., Lin LC., Wu SC., Lin JG. (1999). The effectiveness of acupressure in improving the quality of sleep of institutionalized residents. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 54(8), 389-394.
#41 Harris RE., Jeter J., Chan P., Higgins P., Kong FM., Fazel R., Bramson C., Gillespie B.( 2005). Using acupressure to modify alertness in the classroom:A
single-blinded, randomized, cross-over trial. Journal of Alternative &
Complementary Medicine, 11(4), 673-679.
#42 王希寶、房淑潔（2004）．放鬆點穴法治療抑鬱症的對照研究．神經疾病與精
神衛生，4（2），116。
#43 Fassoulaki A., Paraskeva A., Patris K., Pourgiezi T., Kostopanagiotou G.. (2003).
Pressure applied on the extra 1 acupuncture point reduces bispectral index values and stress in volunteers. Anesthesia & Analgesia, 96(3), 885-890.
#44 Agarwal A., Ranjan R., Dhiraaj S., Lakra A., Kumar M., Singh U. (2005).
Acupressure for prevention of pre-operative anxiety: a prospective, randomised, placebo controlled study. Anaesthesia, 60(10), 978-981.
#45 Chen LL., Hsu SF., Wang MH., Chen CL., Lin YD., Lai JS. (2003). Use of acupressure to improve gastrointestinal motility in women after
trans-abdominal hysterectomy. American Journal of Chinese Medicine, 31(5), 781-790.
#46 李金婷、裘月娟（1996）．穴位按摩用於腹部術後胃腸功能恢復的觀察．天津
護理，4（1）1-2。
#47 盧燕、樊艷艷（2003）．按摩足三里穴促進腹部手術後胃腸功能恢復的研究．解 放軍護理雜誌，20（5），13-4。
#48 李光泉、高宗康（1995）．按摩足三里穴促進腹部手術後胃腸功能得恢復作用．
#52 Maa SH., Gauthier D., Turner M. (1997). Acupressure as an adjunct to a pulmonary rehabilitation program. Journal of Cardiopulmonary Rehabilitation, 17(4), 268-276.
#53 葉倩菁（2004）．穴位按壓療法對呼吸器昏迷病患脫離呼吸器參數之成效．未 發表的碩士論文，台北：長庚大學護理學研究所。
#54 Tsay SL., Wang JC., Lin KC., Chung. UL. (2005). Effects of acupressure therapy for patients having prolonged mechanical ventilation support. Journal of
Advanced Nursing, 52(2), 142-150.
#55 王瑞琴（2003）．穴位指壓在呼吸器依賴患者焦慮、睡眠品質及自發性呼吸參
數成效之探討．未發表的碩士論文，台北：國立台北護理學院護理研究所。
#56 Wu HS., Wu SC., Lin JG.., Lin LC. (2004). Effectiveness of acupressure in improving dyspnoea in chronic obstructive pulmonary disease. Journal of Advanced Nursing, 45(3), 252-259.
#57 Maa SH., Sun MF., Hsu KH., Hung TJ., Chen HC., Yu CT., Wang CH., Lin HC.
(2003). Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: a pilot study. Journal of Alternative &
Complementary Medicine, 9(5), 659-670.
#58 李超英（2005）．穴位按摩治療急性鼻炎療效觀察．中國實用鄉村醫生雜誌，
#64 Yuksek MS., Erdem AF., Atalay C., Demirel A. (2003). Acupressure versus oxybutinin in the treatment of enuresis. Journal of International Medical Research, 31(6), 552-556.
#65 李白玉（1999）．點穴防治藥物流產後陰道出血過多．中國針灸，（5）312。
#66 楊曼華（2000）．穴位指壓對改善癡呆症老人問題行為之成效．未發表的碩士 論文，台北：國立陽明大學臨床護理研究所。
#67 Felhendler D., Lisander B. (1999). Effects of non-invasive stimulation of acupoints on the cardiovascular system. Complementary Therapies in Medicine, 7(4), 231-234.
#68 董瑞馨、蘇玉文、孫中安、孫婷、鄭亮、孫曉雲（2004）．穴位按摩輔助治療
糖尿病伴周圍神經病變療效觀察．護理學雜誌，19（23），32。