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以電漿刀PEAK與電燒刀施行懸壅垂腭咽成形術之術後疼病比較

Comparison of Post-operative Pain between Pulsed Electron Avalanche Knife (PEAK) and Electrocautery in Uvulopalatopharyngoplasty

摘要


背景:傳統以電燒刀施行睡眠外科手術,因電燒刀產生之高溫造成人體組織熱傷害,使病患術後感到明顯的疼痛。電漿刀能在較低溫下切割組織,預期能減少病患術後疼痛。因此,本文比較以電漿刀與電燒刀施行懸壅垂腭咽成形術之術後疼痛。方法:2011年7月至2011年12月期間,共計40名病患(男38,女2)因中度至重度阻塞性睡眠呼吸中止症合併鼻塞症狀至本院求診,接受懸壅垂腭咽成形手術併鼻中膈鼻道成形術,平均年齡38.4歲。以問卷評估比較使用電漿刀與電燒刀施行懸壅垂腭咽成形術之術後疼痛。結果:電漿刀組(24名)與電燒刀組(16名)病患之性別分布,年齡,身體質量指數、呼吸中止及低下指數,左右側扁桃腺大小皆無顯著差異。疼痛視覺量表於術後第1,3,7,14,21天之平均分數兩組有顯著差異,電漿刀組疼痛較電燒刀組輕微(p < 0.05)。術後第3天之疼痛多元量表顯示,除吞嚥時耳朵痛程度無顯著差異外,整體疼痛程度、喉嚨疼痛程度、吞嚥時喉嚨疼痛兩組皆有顯著差異(p < 0.05),電漿刀組疼痛較電燒刀組輕微。疼痛對日常生活妨礙量表顯示,術後第3,7,14天兩組有顯著差異,電漿刀組妨礙較電燒刀組輕微(p < 0.05)。術後服用止痛藥之天數、術後恢復正常飲食所需之天數、病患對疼痛控制之滿意度,電漿刀組表現皆較電燒刀組為佳(p < 0.05)。結論:與電燒刀相較,電漿刀施行懸壅垂腭咽成形術之術後疼痛較輕微,使用止痛藥之天數較少,回復正常飲食所需天數較短,病患之疼痛控制滿意度亦較高。

並列摘要


Background: Performing sleep surgery using electrocautery causes significant pain due to thermal tissue injury. A pulsed Electron Avalanche Knife (PEAK) can cut through tissue at lower temperatures, and is expected to reduce post-operative pain. Therefore, in this study, we attempted to compare post-operative pain between PEAK and electrocautery for uvulopalatopharyngoplasty (UPPP). Methods: From July 2011 to December 2011, 40 patients (38 males and 2 females; average age, 38.4 years) with moderate to severe obstructive sleep apnea (OSA) and nasal obstruction underwent UPPP and septomeatoplasty at our hospital. We used questionnaires to compare post-operative pain between PEAK and electrocautery for UPPP. Results: No significant difference was observed in sex distribution, age, body mass index (BMI), apnea-hypopnea index (AHI) or tonsil size between the PEAK group (N = 24) and the electrocautery group (N = 16). The mean visual analogue scale (VAS) pain scores on post-operative days 1, 3, 7, 14, and 21 in the PEAK group were less than those in the electrocautery group (p < 0.05). The overall pain, throat pain, and swallowing pain on post-operative day 3 in the PEAK group were milder than those in the electrocautery group (p < 0.05). No significant difference was observed in the degree of ear pain during swallowing on post-operative day 3 between the PEAK and electrocautery groups. Hamper of life on post-operative days 3, 7, and 14 in the PEAK group was less than that in the electrocautery group (p < 0.05). The PEAK group had lesser number of days for taking painkillers, lesser number of days required for return to normal diet and higher patient satisfaction for pain control than the electrocautery group (p < 0.05). Conclusions: Compared with electrocautery, using PEAK for UPPP resulted in milder post-operative pain, lesser number of days for taking painkillers, lesser number of days required for return to normal diet and higher patient satisfaction for pain control.

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