全膝關節置換術病患術後疼痛程度對復原程度的影響

The Impact of Post-Operative Pain on Outcomes Following Total Knee Replacement

程金瀛(Chin-Ying Cheng)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學研究所/碩士(2006年)

摘要

膝關節炎好發於老年病患，台灣進入老人國的時代，罹患關節炎的病患與日俱增，在消極治療仍然無法改善關節症狀的情況下，施行全膝關節置換術已然成為必要的處置。中央健保局（1998）統計每年接受全膝關節置換術的病患超過8000人次，此項手術所耗費的成本為所有住院處置的第二位。因此，提昇手術的成效、減少影響復原的干擾因子，將成為病患、醫療人員及管理階層最為關心的議題。從過去研究中發現手術病患在手術後的傷口疼痛會影響其復原之成果，因此假設病患手術後傷口疼痛程度影響全膝關節置換術後三十天膝關之節復原程度，本研究採用橫斷式描述性相關性研究，研究工具為基本資料表、簡明疼痛量表（Brief Pain Inventory）和膝關節評分表﹙ Knee Society Score﹚，以方便取樣於北部二家區域教學醫院及一家地區教學醫院進行收案，共收52名接受全膝關節置換術之55歲以上個案。以描述性統計、皮爾森相關、單因子變異數分析及回歸分析進行資料分析。研究結果顯示：手術後傷口疼痛程度對於手術後膝關節復原程度並無顯著相關。手術後復原程度依膝關節評分表﹙Knee Society Score﹚分為膝關節評分（Knee score）和膝功能評分（Functional score）二部分進行分析，病患對照顧者之滿意度越高則手術後三十天膝功能改變量越大。止痛劑使用越多種類則手術後三十天膝關節評分改變量越少，止痛劑使用頻率越高則手術後膝功能評分改變量越少。 本研究結果顯示，疼痛對於關節手術後的復原並無顯著影響，但是疼痛確實是手術後病人最關切的問題之一，也影響手術後急性期下床活動的時間，而手術後及早下床活動是減少手術併發症的有效方法之一。本研究限於時間因素收案數量較少且收案時間在手術後一個月，對於大部分的病患而言，都還未達到實際復原的程度，必須依賴助行器或他人協助進行日常活動，因此未來研究可增加收案數並延長觀察時間為三個月，將更能確切的呈現疼痛對短期復原的影響程度。

關鍵字

全膝關節置換術、傷口疼痛、關節復原程度

並列摘要

Taiwan become an agedness country at this time, There are more and more people suffers from contracts the arthritis sickness to grow day by day, still was unable in the negative treatment to improve the joint symptom in the situation, executed the total knee joint replacement already to become essential handling. The central health insurance bureau (1,998) counts every year to accept the entire knee joint to replace the technique patients to surpass 8,000 people, this item of surgery consumes the cost for all is hospitalized handling second. Therefore, the promotion surgery result, the reduced influence recovers the disturbance factor, will become the patients, the medical officer and the management social stratum nicest subject. Studied from the past research surgery patients could affect it after the surgery wound ache to recover the achievement, after therefore the supposition patients surgery the wound ache degree affected the total knee joint replacement latter 30 days knees to close the festival to recover the degree, this research used demographic form and basic document table, Brief Pain Inventory and the Knee Society Score .52 subjects were recruited by convenience sampling at two teaching hospital and an area teaching hospital in north of Taiwan. Data were analyzed using descriptive statistics, pearson’s correlation, regression analysis. The results showed that, the wound ache degree of post surgery is not reveals the correlation with knee joint recovers the degree. After the surgery recovers the degree to Knee Society Score according to the knee joint to divide into the knee joint to grade Knee score and the Functional score two parts to carry on the analysis, patients goes past high the attendance satisfaction of to then the surgery latter 30 days knees function difference is bigger. Use more pain killer types then the knee joints grade difference of post surgery latter 30 days is fewer, more pain killer frequency of use then the knee function grades difference of post surgery are less. This finding showed that, the ache recovers after the joint surgery and not reveals the influence, after but the ache truly is the surgery one of patient kindest questions, after also affects the surgery the acute time to get out of bed the active time, after but the surgery early gets out of bed the activity reduces one of surgery illness complication effective methods. This research is restricted in the time factor to receive the document quantity to be less also to receive the document time in the surgery latter month, says regarding the majority of sickness, all had not achieved actually recovers the degree, must rely on helps the line or the other people assists to carry on the daily activity, therefore the futurology might increase receives the document number and lengthens the viewing time is three months, will be able accurate to present the ache the influence which will recover to the short-term.

並列關鍵字

total knee joint replaces, post surgery wound ache, the difference of joint recovers

參考文獻

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