病患對術後疼痛及麻醉風險之認知與態度

Patients' Perceptions and Attitudes toward Postoperative Pain and Anesthesia Risks

黃百慶(Pai-Ching Huang) ； 陳坤堡(Kuen-Bao Chen) ； 劉時凱(Shih-Kai Liu) ； 劉玉成(Yu-Cheng Liu,) ； 陳慶鴻(Ching-Hung Chen) ； 吳世銓(Rick Sai-Chuen Wu)

《疼痛醫學雜誌》 19卷2期 (2009/09) Pp. 55-63

https://doi.org/10.29792/TTJP.200909.0002

摘要

病患對手術前後麻醉相關的醫療認識普遍不足，諸如麻醉前的檢查及準備、麻醉的風險、術後的疼痛控制等等，因而造成病患的焦慮與恐懼。但國內鮮少有針對手術病患麻醉前後焦慮與恐懼的相關內容進行研究。本研究透過問卷於術後訪視病患的方式，統計手術病患在接受現行麻醉前評估及解釋之後，針對麻醉前後可能焦慮及恐懼的內容進行分析。
結果發現：雖然現行的麻醉前訪視符合多數手術病患的期待，但平均四位當中仍有一位病患對麻醉不予重視，對於術前有無麻醉科醫師訪視感到無所謂。術前超過一半的病患非常擔心術後傷口疼痛的問題，約四分之一的病患非常擔心經不過來，另外約四分之一的病患則非常擔心手術中清醒或聽到有人在講話。而女性病患非常擔心醒不過來的比率明顯比男性病患來的多。女性於接受麻醉前焦慮與恐懼的比率普遍高於男性。超過九成五以上的病患認爲手術後的疼痛是不可避兔的。病患術後發生中重度疼痛則佔七成以上。只有兩成的病患術後疼痛比預期不痛。超過四分之三的病患對於術後疼痛會忍耐到痛到受不了才告知醫護人員。約有三成五病患認爲術後使用止痛藥容易成癮，尤其是受過大專以上教育的病患，更有一半以上認爲術後止痛藥物容易成癒。有超過四分之一的病患覺得將術後疼痛告訴醫護人員會造成醫護人員的困擾。女性術後疼病的程度較男性高，並不是因爲對術後疼痛控制的認知有較男性更多的偏差所導致。
麻醉科醫師的臨床工作十分繁重，能與病患有比較長時間溝通的機會只有在麻醉前訪視。本研究提供麻醉科醫師以病患的我點所統計出麻醉相關的認知與態度的數據，使麻醉科醫師在國內醫療環境下很有限的訪視時間內，能有效地爲手術病患解釋麻醉、分析麻醉前中後病患擔心的部分爲何、衛教病患麻醉前中後相關醫療事宜，以期能降低手術病患的焦慮與恐懼，進而提高手術病患的麻醉相關醫療品質。

關鍵字

手術後疼痛 ； 麻醉前評估 ； 麻醉風險

並列摘要

Patients' anxiety and fear prior to the anesthesia are mostly due to inadequate understanding of anesthesia, including the significance of pre-anesthesia assessment, risks of anesthesia, and post-operative pain control. In Taiwan, there are few studies focused on the exact contents and to what extent the patients' anxiety and fear are prior to the anesthesia. This study is conducted by post-operative visit with a uniform questionnaire filled out by the patients, who have received pre-anesthesia assessment and explanation. The questionnaire is designed to focus on the patients' perceptions and attitudes toward post-operative pain and anesthesia risks.
In this study, we find that most patients would like to have anesthesiologist s visit before the operation, however, there are 25% patients don't care about that. Pre-operatively, fifty four percent patients worry about post-operative pain very much, while 25% patients worry badly about that he or she cannot wake up anymore, and 25% patients are very worried about awareness during the operation, Generally speaking, female patients are more anxious than male patients, especially when it is referred to cannot wake up from the anesthesia. Over 96% of the patients believe that post-operative pain is inevitable. Moderate to severe pain occurs post-operatively in more than 70% of the patients, while there are only 20% of the patients perceive less severe post-operative pain than what they anticipated. Over 77% patients would not call a nurse until their pain is intolerable. About 35% patients consider that opioids used for post-operative pain control are highly addictive, whereas there are even more than half of the patients believe so among high-educated patient group,
Pre-anesthesia assessment is almost the only chance for a patient to realize what exactly happens during peri-anesthesia period. But the time is usually too limited to learn everything include what the patient fears. This study discloses several useful clinical clues for an anesthesiologist to provide a patient more effective pre-anesthesia assessment in terms of improving quality of anesthesia by reducing patients' fear peri-operatively.

並列關鍵字

pre-anesthesia assessment ； post-operative pain ； anesthesia risks