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  • 學位論文

探討退化性膝關節炎老人接受單側全膝關節置換術前、後的疼痛、日常活動功能、自覺能量之現況及變化

The current status and changes in pain, activity of daily living, and perceived energy among elderly osteoarthritis patients undergoing unilateral total knee replacement surgery

指導教授 : 許心恬

摘要


本研究要探討退化性關節炎老人接受單側全膝關節置換術前、後的疼痛、日常活動功能、自覺能量之現況及變化。研究採前瞻性類實驗縱貫式研究設計,以方便取樣方式收案58位接受單側全膝關節置換手術的病人,以10 cm疼痛數字評價量表(NRS)合併臉譜量表來測量疼痛程度;以感知日常生活活動能力量表(The Index of Self-Report ADL)來測量日常活動功能;以安適圖量表(Well-Being picture scale;WPS)來測量自覺能量的程度,測量時間為術前一天、術後48小時、出院前一天。本研究結果顯示接受單側全膝關節置換術的個案大多是女性、平均年齡74歲、已婚、教育程度國小以下、與家人同住者居多。手術前日常活動功能總分平均分數93.76±6.10,屬於部分獨立;疼痛平均分數為6.36±1.88,屬於中等程度疼痛;自覺能量總分平均為59.93±9.44,屬於中高的自覺能量。退化性關節炎老人隨著手術完成至出院前,疼痛情形有明顯的改善。而日常活動功能於手術前最好,手術後有明顯下降且功能最差,出院前日常活動功能逐漸往上提升。退化性關節炎老人的自覺能量在手術前後差異不大,出院時有明顯的上升。不論術前、術後或出院前,有使用輔具老人的疼痛分數均較無使用輔具老人明顯得分高,較為疼痛。居住環境為獨棟透天厝患者,在三個時段的日常活動功能皆高於居住於平房患者。 藉由本研究結果,可讓臨床醫護人員了解退化性關節炎老人接受單側全膝關節置換術前、後及出院前個案的疼痛、日常活動功能與自覺能量之現況與變化,篩選出高危險群個案,適時提供介入措施,協助個案順利回歸社區生活。

並列摘要


This study aimed to explore the current status and changes in pain, activity of daily living (ADL), and perceived energy among elderly osteoarthritis patients before and after unilateral total knee replacement surgery. A prospective, longitudinal, quasi-experimental research design was used. A convenience sample of 58 patients undergoing unilateral total knee replacement surgery was recruited. A 10-cm numerical rating scale (NRS) with face rating scale was used to measure the level of pain; the Index of Self-Report ADL was used to measure the level of ADL; the Well-Being Picture Scale (WPS) was used to measure the level of perceived energy. All participants were measured at three time points: the day before surgery, 48 hours after surgery, and the day before discharge. The results of this study showed that most of the polled participants, with a mean age of 74 years, were female, married, and had an education level below elementary school and lived with family. The mean total score of preoperative ADL was 93.76 ± 6.10, indicating partial independence in ADL; that of preoperative pain was 6.36 ± 1.88, indicating a moderate level of pain; that of preoperative perceived energy was 59.93 ± 9.44, indicating a moderate to high level of energy. The pain in elderly osteoarthritis patients significantly improved after surgery and before discharge. The highest level of ADL was reported before surgery, while a significant reduction and the lowest level of ADL were reported after surgery; the level of ADL gradually elevated before discharge. There were only slight differences in perceived energy between before and after surgery; however, a significant increase was detected before discharge. The pain scores were significantly higher (indicating greater pain) in the elderly who used assistive devices than in those who did not no matter before or after surgery or before discharge. The levels of ADL were higher in the elderly who lived in a detached dwelling than in those who lived in a bungalow at all three time points. The study findings provided an in-depth understanding of the current status and changes in pain, ADL, and perceived energy among elderly osteoarthritis patients undergoing unilateral total knee replacement surgery. The results could help medical professionals screen high-risk individuals, provide timely intervention strategies, and assist patients to return to their community as smoothly as possible.

參考文獻


明金蓮、洪曉佩(2011).急性疼痛評估與症狀護理.源遠護理,5(1),11-16。
參考資料
丁于齡(2005).消化系統癌症惡病質患者營養、焦慮及感知能量之
相關性研究.未發表的碩士論文.高雄:高雄醫學大學護理研究

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