疼痛症狀病人手術後疼痛控制品質的測量、改變趨勢與相關因子之探討

研究目的疼痛是身體一個重要指標也是手術病人最在意的問題，本研究的目的是為了探討手術病人疼痛之改變趨勢、不同疼痛控制品質評估工具在住院期間之敏感度及術後病人基本屬性、術前健康相關生活品質與疼痛控制品質之相關，以提供醫療院所推動疼痛控制品質上的參考與修正。研究方法本研究方法是縱貫性之前瞻性研究設計，針對疼痛病人接受手術後在住院第一、三、五天內的疼痛控制品質之測量、改變趨勢及其相關因子探討。研究工具為結構式問卷，有簡明疼痛量表(BPI)、疼痛控制品質問卷（APS-POQ）、健康相關生活品質(SF-36)、疼痛及麻醉性止痛藥信念量表- 手術疼痛版(POABS-SP )。研究對象為88位有疼痛症狀手術病人，以 SPSS15.0以及Stata9.0統計軟體分析個案接受手術後疼痛控制與整體健康生活品質資料是否具相關性。研究結果研究結果顯示疼痛趨勢呈顯著的改變曲線，術後第一天疼痛強度重度者多，術後第五天身體疼痛呈顯著性差異，疼痛對活動功能影響只有睡眠呈顯著性差異，而生活品質活力狀況在術後五天內尚無法復原；以Effect Size比較工具之差異，結果顯示術前至術後第五天BPI比 SF-36評估工具Effect Size呈顯著的正相關；以GEE探討重複測量改變量及其受到時間因素多變項相關分析裡，經過時間校正控制後，顯示疼痛、活動功能與手術方式、傷口大小呈顯著性差異；對疼痛處理的滿意度中，以醫師滿意度與手術部位及麻醉方式、中學教育程度達顯著性差異。結論與建議透過多重疼痛控制品質工具 BPI與APSPOQ兩者，在疼痛方面不管是一週或24h的評估均是有顯著性的改變差異，這表示在急性疼痛病人疼痛的改變率是高的，所以第五生命徵象疼痛評估每日執行評估是需要的，且術後至術後第三天測量頻率可做為日後研究方向。

關鍵字

術後疼痛；疼痛信念滿意度健康相關生活品質

並列摘要

Purpose Pain is an important indicator of health of patients are most concerned about is the question of the purpose of this study was to explore the pain of surgery to change the trend f patients, different pain assessment tools for quality control during hospitalization and post-operative sensitivity of the basic attributes of patients, preoperative ,health-related quality of life and quality control of pain related to the provision of medical institutions to promote quality control pain and correcting the reference. Method This study is the prospective longitudinal study design, to investigate patient response to pain after surgery in the hospital first, three to five days of the change in the quality of pain control trends and related factors to explore. Research tools for the structured questionnaire, a Brief Pain Inventory (BPI), American Pain Society's Patient Outcome Questionnaire (APS-POQ), Health Related Quality of Life (SF-36), Pain and Opioids Analgesics Beliefs Scale-Surgical Pain Version (POABS-SP). Study for 88 patients have pain in order to SPSS15.0 and analysis of statistical software Stata9.0 cases pain control after surgery the quality of life and overall health information is relevant. Result The results showed that pain was a significant change in the trend curve, after the fifth day of physical pain there was significant difference, the impact of pain on functional activities was on1y significant difference between sleep, and vitality of the status of qua1ity of life within five days after surgery is not restoration; to Effect Size comparison of the differences in tools, results showed that preoperative and postoperative first day of BPI than the SF-36 assessment tool of the Effect Size was a significant positive correlation; to explore GEE repeated measured by volume and the time factor in multivariate analysis, after the time correction control to show pain, function and operation activities, wound size differences were significant; of satisfaction with pain management, with physician satisfaction with the surgical site and anesthesia, secondary education level of significant differences. Conclusion The quality of pain control through the multi-tool BPI and APS-POQ both, in regard to 24h pain or a week pain, whether the assessment is a significant difference in changer which means that patients in the acute pain of the change in the rate of pain is high, so the fifth vital signs to assess the implementation of daily pain assessment is necessary, and after the third day after operation can be used as a measurement of the frequency of future research directions.