- 學位論文
使用不同止痛方式病人術後噁心嘔吐發生率及止痛效果差異之相關因素探討
Analysis of incidence of post-operative nausea and vomiting and analgesic effect in relation to different post-operative analgesic regimens and patient’s factors.
摘要
本研究目的在於希望探討使用不同的術後止痛方式，對病人術後噁心嘔吐(Post Operative Nausea Vomiting, PONV)的發生及止痛效果是否有不同的影響。 研究期間為2007年1月1日至2008年10月31日止，以回溯性研究及立意取樣方式收集病人資料，經由中部某區域教學醫院之脊椎手術麻醉病人，收集麻醉後訪視統計資料及病歷查閱方式進行調查。依術後止痛方式將其分為兩組病人，A組病人使用傳統術後止痛方式止痛，有效樣本51人次；B組病人使用自控式止痛方式(patient controlled analgesia, PCA)止痛，有效樣本134人次。止痛藥以嗎啡(Morphine)為主要術後止痛藥，觀察術後24小時內，病人噁心嘔吐發生率及止痛效果之差異情形，以探討影響兩組病人使用不同術後止痛方式，其噁心嘔吐發生率及止痛效果差異之相關因素。所得資料以 SPSS 12.0中文版統計套裝軟體進行建檔分析，進行描述性統計、獨立t 檢定、卡方檢定及單變項與多變項之推論性分析。 本研究重要結果如下： 一、 不同止痛方式對術後噁心嘔吐發生率之比較，兩組間無顯著統計差異。 二、 不同止痛方式對術後止痛效果之比較，PCA組之術後止痛效果較傳統組好，具顯著統計差異(P＜0.05)。 三、 不同止痛方式對術後疼痛控制滿意度之比較，兩組間無顯著統計差異。 本研究結果顯示脊椎手術後病人，使用PCA方式比傳統方式有較佳之止痛效果，副作用之噁心嘔吐發生率及病人術後疼痛控制滿意度，兩組間並無差異。本研究對醫界之建議: 一、醫護人員應積極於手術前建立病人術後疼痛照護計畫。 二、 術後病人之疼痛評估(第五生命徵象)，應納入醫院臨床路徑醫囑。 三、持續進行PCA的研究。
並列摘要
The purpose of this research is to investigate if the incidence of postoperative nausea and vomiting (PONV) and analgesic effect are different in different analgesic regimen for post-operative pain management. It was a retrospective study; the data were reviewed during a period from January 1st 2007 to Oct. 31st 2008 for the patient who received spinal operation in one of the regional teaching hospital of middle region of Taiwan. The enrolled patients were divided into two groups according to the analgesic method for postoperative pain management. There were 51 patients received traditional analgesia in Group A and 134 patients received patient controlled analgesia (PCA) in Group B for postoperative pain management. Morphine was the main analgesic and the differences of the incidence of PONV and analgesic effect between two groups were observed for 24 hours postoperatively. The PONV, analgesic effect and the correlation factors of two analgesic regimens were investigated. All statistical analyses were performed with SPSS (version 12.0) and student’s test, Chi-square test were used to analyze the collected data. The important results of the study were as follow: 1) There was no significant difference of PONV between two groups 2) The analgesic effect of Gr.B (PCA) was better than Gr.A (P<0.05) 3) There was no significant difference of patient satisfaction between two groups. The result of the study showed that the analgesic effect was better in PCA than traditional analgesia and no significant differences in the incidence of PONV and patient satisfaction. The study suggested 1) The medical personnel should set up a plan of postoperative pain management before operation aggressively. 2) Postoperative pain assessment (the fifth vital sign) should include in the clinical pathway of clinical care. 3) Continues to investigate the effect of PCA.