影響不合作孩童就診時 合併身體束縛後行為表現的各項因素探討

Abstract

年幼的兒童在牙科治療時顯現不合作行為，常需合併身體束縛的使用，才能使治療順利地進行。雖然身體束縛在兒童牙科界偶爾使用，但相關研究卻不多。 研究目的：本實驗的目的欲探討治療不合作孩童，需使用身體束縛時，影響孩童行為的多種因素，以增進牙醫師對使用身體束縛時的瞭解。 實驗對象與方法：139位二歲至六歲學齡前孩童，因不合作行為，治療時需合併身體束縛者為觀察對象。以固定式攝影機全程記錄。再由兩位實驗記錄者獨立觀看影片，並分別逐項紀錄孩童之年齡、性別、牙醫師行為（Weintein dentist rating scale）、孩童行為（Frankl scale）家長陪同與束縛板使用次數等項目。最後，以迴歸模型進行多變項因子分析。 結果及結論：影響孩童第二次與末次就診時，是否使用束縛板和行為是否合作的因素與孩童的年齡、就診的次數、家長是否陪伴、牙醫師行為：「導引、指示」、「建立回饋」、「身體接觸」與「交談、對話」有關，其中又以「建立回饋」和「身體接觸」影響最大。而孩童性別、牙醫師行為：「同理心」則無顯著的影響。唯一影響三歲以下孩童行為的因素為家長的陪伴，然而此因素對三歲以上孩童則無顯著影響。牙醫師的行為對三歲以下孩童合併使用身體束縛並無顯著影響，而牙醫師行為：「建立回饋」和「身體接觸」則對三歲以上孩童末次就診時是否使用身體束縛、行為是否合作有顯著影響。

The purpose of using physical restraints during dental treatment for an uncooperative child is to gain cooperation for a safe course of treatment. However, there are few research about the clinical use of restraints. Purpose: To find factors that may positively guide the child’s behavior and reducing use of physical restraints during dental treatments. Material and method: The sequential treatment sessions of 139 uncooperative children, age 2~6 year-old, who were treated under physical restraint were video-recorded. Two trained observers independently scored the behavior of children with the Frankl scale and that of dentists with Weinstein dentist rating scale. Multi-variate logistic regression model was used for data analyses. Results: Data analysis showed that children’s age, number of visits, parental company, and the dentist’s behavior: feedback and physical contact affect the child’s behavior under physical restraint. (p<0.01) Considering of child’s age : when children are younger than 3 years old, the only factor influences the use of restraint is parental company. But the presence or absence of parent did not affect the behavior of child who is older than 3 years old. For 3 years old or older children, the dentist’s behavior “feedback” and “physical contact” have significant effect on the probability of using restraint. However, when children are under 3 years old, the cooperation of children and the use of restraint could not be influenced by any strategies for behavior management by dentists.