| 摘要: | 背景：過敏性鼻炎是慢性病之一。目前，過敏性鼻炎的治療是以避免過敏原、藥物治療以及手術治療為主。但是，這些治療仍存在治療效果不佳，以及可能有藥物或手術治療之副作用所困擾。因此，若能另外找到一種非藥物與非外科手術的有效方法，將有助於過敏性鼻炎的治療。遠紅外線可以促進自律神經系統之正常運作，並改善血液循環，推測可緩解血管性、特異或非特異性過敏性鼻炎等過敏之不適症狀。因此，在理論上可預期遠紅外線對於過敏性鼻炎應該有療效。 研究目的：探討過敏性鼻炎患者在接受藥物治療時，輔以遠紅外線介入是否可以有效提升改善打噴嚏、流鼻涕、鼻塞及鼻、眼結膜癢過敏症狀、促進健康及提升生活品質。 材料及方法：本研究為類實驗設計，收案對象為南部某區域教學醫院，耳鼻喉科門診過敏性鼻炎患者採立意取樣，對象為年滿20-50歲，臨床確診過敏性鼻炎的診斷患者，並隨機分配為實驗組（抗組織胺及類固醇鼻噴劑藥物治療合併遠紅外線治療；30人）及對照組（藥物抗組織胺及類固醇鼻噴劑治療；20人）。實驗組在接受抗組織胺、類固醇鼻噴劑藥物治療期間合併使用遠紅外線熱敷墊，每週使用3次以上，每次40分鐘，熱敷位置包含頭、肩頸、背及腰背部；其中包含中醫改善過敏性鼻炎常使用之大椎、定喘、大杼、風門、肺俞、脾俞、腎俞等穴位。此外，患者在急性期亦合併臉部眼鼻處之熱敷。再者，本研究亦使用基本資料問卷（前測）、台灣版SNOT-20鼻及鼻竇炎評估量表（前、中、後測）及WHOQOL-BREF以台灣簡明版世界衛生組織生活品質問卷為基礎的過敏性鼻炎問卷量表進行問卷調查，並抽血檢驗Ig-E與嗜酸性細胞陽離子蛋白eosinophil cationic protein（前、後測）。兩組在介入前先進行前測，並於第四週執行後進行第一次後測，於第十二週後執行進行第二次後測；並以統計分析評估之。數據資料以SPSS 22.0 統計軟體進行統計分析。收案時間為民國104年4月20日至民國105年06月30日。 結果：實驗及對照兩組之鼻及鼻竇炎評估量表在前、後測皆有顯著改善(p<0.05)。WHOQOL-BREF以台灣簡明版世界衛生組織生活品質問卷為基礎的過敏性鼻炎問卷量表之前、後測總分平均數在兩組均達顯著差異（實驗組：p=0.041；對照組：p=0.000），但實驗組高於控制組。此外，本研究結果亦發現：（1）有效改善過敏性鼻炎症狀及降低引發鼻竇炎及氣喘的合併症及預防過敏性鼻炎發生。（2）改善因過敏性鼻炎造成的睡眠障礙實驗組(p=0.000)優於控制組(p=0.321)，維持社會功能（實驗組：p=0.364；控制組：p = 0.219）提升生活品質。（3）有效提升強健呼吸系統免疫力減少感冒次數及減少合併症如鼻竇炎（實驗組： p=0.005；控制組：p=0.014）或氣喘發生（兩組12週受試期間無合併氣喘發作）。（4）調和中醫體質實驗組 (p=0.015) 優於藥物控制組 (p=0.385)。（5）兩組前、後測在IgE及ECP抽血檢驗上皆未達顯著差異 (p >0.05) 。 結論: 藥物合併遠紅外線整合性療法與一般中、西醫治療過敏性鼻炎相較，其症狀可以有效改善並可提升生活品質、維持社會功能及減少口服用藥的劑量、合併治療的種類，達到降低健保醫療支出之效果，故遠紅外線介入可以有效應用於過敏性鼻炎之輔助醫療。
Background : Allergic rhinitis is one of the chronic illnesses. At present, the major treatments for allergic rhinitis are avoiding allergens, medical treatment and surgery. However, inadequate effects, and possible side effects of these treatments are still problems to these patients. Therefore, to find an effective non-medical and non-surgical treatment will be of great help in treating patients with allergic rhinitis. Far-infrared radiation is able to promote normal operation of autonomic nervous system, to improve blood circulation and thereby assumed to relieve discomfort symptoms of patients with vascular, specific or non-specific allergic rhinitis. Consequently, far-infrared radiation is expected to be effective for the treatment of allergic rhinitis. Research Purposes: We aimed to investigate the adjunct effects of far-infrared radiation in improving allergy symptoms like sneezing, rhinorrhea, nasal obstruction, nose and conjunctiva itching during a medical treatment for patients with allergic rhinitis. Moreover, the impact of far-infrared radiation on health and life quality promotion will also be studied. Materials and Methods: This is a quasi-experimental design. The study subjects are recruited from patients visited to a Ear-Nose-Throat Out Patient Department in a regional teaching hospital in south Taiwan. The sampling method is purposive sampling. The inclusion criteria are adults between 20 and 50 year-old with a definite clinical diagnosis of allergic rhinitis. Subjects were randomly distributed as experimental and control groups. Thirty persons in the experimental group used both medical and far-infrared radiation as management. On the other hand, twenty persons in the control group used only medical treatment. Patients in experimental group received anti-histamine, steroid nasal spray and far-infrared radiation hot pad for 40 minutes per time, and more than three times per week. The locations of hot pad included head, neck and shoulder, back and lower back. These locations covered many acupuncture points f -requently used by traditional Chinese medicine for the treatment of allergic rhinitis. These acupuncture points are Da-Zhui, Din-Chuan, Da-Yu, Fon-Men, Fei-Yu, Pi-Yu, Shen-Yu. In addition, patients also received hot pad over face, eyes and nose during acute stage of allergic rhinitis. Meanwhile, we used a questionnaire as a pre-test to collect basic information, and Taiwan’s SNOT-20 nose and sinusitis evaluation form as pre- middle and post-test. WHOQOL-BREF and Taiwan’s concise edition of WHOQOL ii questionnaire were also used as basic data collection tools for allergic rhinitis. Furthermore, blood tests for patient’s serum IgE and eosinophil cationic protein levels were determined before and after experiment. The timing for pre-test of the experimental and control group are before the intervention, the first post-test was performed 4 weeks later, and the second post-test was carried out 12 weeks later. Data was analyzed by spss 22.0 software . The study period is from Apr. 20, 2015 to Jun. 30, 2016. Results: Both pre- and post-tests of Taiwan’s SNOT-20 nose and WHOQOL-BREF Taiwan’s concise edition WHOQOL ii questionnaire for life quality evaluation showed a significant improvement in both experimental and control groups(p<0.05). Moreover, we also found that (1) symptoms of allergic rhinitis and the ability to reduce the occurrence of allergic rhinitis and sinusitis as well as asthmatic complication were effectively improved; (2) sleep disorder aroused by allergic rhinitis was also improved, life quality is hence promoted by the maintenance of a better social function; (3) by effectively strengthening the immunity of respiratory system, the occurrence of common cold and complication like sinusitis were reduced; (4) regarding the reconciling of traditional Chinese medicine constitution, the experimental group was significantly better than the control group (p=0.015); (5) both pre- and post-tests of serum IgE and ECP level did not show a significant difference in both experimental and control groups(p > 0.05). Conclusion: Medical treatment with far-infrared radiation in treating allergic rhinitis, compared to general traditional Chinese or western medicine, can effectively improve symptoms. With these the goal of promoting life quality, maintaining social function, reducing doses of oral medicine and kinds of combined therapy, decreasing medical expense of National Health Insurance,will be reached. We concluded that far-infrared radiation is promising to be an alternative treatment for allergic rhinitis. |
