比較早期改變臥位與手術後平躺六小時其硬脊膜穿刺後頭痛的發生率～以採脊髓麻醉之腹股溝疝氣手術病人為例

Comparison of Postdural Puncture Headache Prevalence in Inguinal Herniaplasty Patients Who Undergo Early Ambulation or 6-Hour Supine Recumbence Following Spinal Anesthesia

林小玲(Shirling Lin) ； 王麗玲(Lin-Ling Wang) ； 謝雅宜(Ya-I Hsieh) ； 連金延(Chin-Yen Lien) ； 石宜銘(Yi-Ming Shyr) ； 鄒樂起(Lok-Hi Chow)

《榮總護理》 35卷2期 (2018/06) Pp. 112-125

https://doi.org/10.6142/VGHN.201806_35(2).0001

摘要

半身麻醉病人接受脊髓麻醉後為預防硬脊膜穿刺後頭痛，通常要求手術後病人平躺6-8小時，然往往使病人有腰酸背痛和解尿困難的情形，本研究目的為比較手術後早期改變臥位其硬脊膜穿刺後頭痛的差異。研究採三組多時間序列前後測之類實驗性設計，研究對象為台北某醫學中心一般外科病房因腹股溝疝氣接受疝氣修補術且採半身麻醉之病人。對照組依傳統手術返室後平躺6小時，實驗A組為手術返室後平躺4小時，實驗B組為手術返病室後即可隨意活動。以廣義估計方程式(Generalized Estimation Equation, GEE)分析不同組別時間序列發生頭痛及相關症狀之差異。主要結果：(一)三組病人發生症狀最多者，依序為腰酸背痛(48%)、頭暈(16%)與解尿困難(11%)；(二)硬脊膜穿刺後頭痛發生率為3%，三組病人頭痛發生率之差異無顯著；三組病人於手術前、術後返室6小時臥床期間及術後七天監測，頭痛發生率之差異無統計顯著差異；(三)對照組腰酸背痛發生率(59%)比實驗B組(30%)高，此差異達顯著；對照組於術後返室時至第6小時腰痠背痛分數逐漸增加，實驗A、B組每個背痛觀察點疼痛分數皆低於對照組。本研究依實證照護應用，建立本土具文化背景的照護常規，結果可作為一般外科病房護理人員針對脊髓麻醉的腹股溝疝氣手術後病人，執行手術後早期改變臥位時的依據，降低脊髓麻醉後平躺導致背痛相關症狀，確保病人獲得完善的照護。

關鍵字

硬脊膜穿刺後頭痛 ； 早期改變臥位 ； 脊髓麻醉 ； 腹股溝疝氣手術病人 ； 實證照護

並列摘要

Background: To prevent postdural puncture headache (PDPH) following spinal anesthesia, postsurgery patients may be advised to lie flat for 6–8 hours. This supine recumbence can result in back pain or dysuria throughout patients' recovery from anesthesia. Objective: To compare the incidence of PDPH between early ambulation and 6-hour supine recumbence groups and to investigate the effectiveness of early ambulation intervention in postspinal anesthesia inguinal herniaplasty patients. Methods: A 3-group time series before-after quasi-experimental design was used. A 6-hour recumbent group, 4-hour recumbent group, and early ambulation group were recruited. The generalized estimation equation of PDPH and backache from the three groups was computed and analyzed. Results: The most common syndromes after surgery were back pain (48%), fainting (16%), and dysuria (11%). No statistically significant differences in the prevalence of PDPH were determined among the 3 groups in the 7-day study period. A significant difference was noted in the prevalence of back pain among the 3 groups. Conclusions: On the basis of the study findings, early ambulation after spinal anesthesia care routine for patients with inguinal herniaplasty should be developed to examine the appropriateness of applying an early ambulation intervention. Furthermore, expanding early ambulation interventions to other spinal anesthesia surgery patients is recommended to improve the quality of postsurgical care for patients in general surgical care units.

並列關鍵字

postdural puncture headache ； early ambulation ； spinal anesthesia ； inguinal herniaplasty ； evidence-based practice

參考文獻

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