疼痛管理對病人手術後疼痛控制之成效--以某醫學中心全膝關節置換術病人為例

The Outcomes of Pain Management on the pain control for postoperation care： Total Knee Replacement patients in a Medical Center

李英春(Ying-Chun Lee)

指導教授 ： 毛莉雯

高雄醫學大學/健康科學院/公共衛生學研究所碩士在職專班/碩士(2004年)

摘要

疼痛是手術後病人所面臨得第一個難題。研究顯示約77%至98%的病患有數後疼痛經驗，有40-80%的病人經歷中等至嚴重程度疼痛，其中40-50%病患的術後疼痛處置是不理想的。本研究目的係探討以『疼痛管理』對TKR手術病人疼痛控制之成效：（1）病人之術後疼痛認知，（2）術後疼痛緩減程度，（3）病人對疼痛處置之滿意度。
本研究對照比較法，針對台灣南部某家醫學中心二個骨科病房中，行TKR手術病人收案，採方便取樣隨機分配實驗組及對照組各為30人，實驗組於術前一天開始接受衛教，對照組接受病房常規性照護；於手術前一天、術後第一、二、三及出院前一天，共五個時間點收集資料。研究工具包括疼痛程度0-10線性數字量表、病患疼痛認知量表、疼痛處置滿意度調查、病歷審核表。統計資料以卡方檢定、獨立樣本t檢定、配對樣本t檢定、回歸分析、單因子重複測量變異數分析加以整理。
研究結果顯示兩組病人同質性高，實驗組個案（1）對術後疼痛認認知前後測進步差異提昇高於對照組、（2）術後疼痛程度低於對照組、（3）對疼痛處置滿意度高於對照組，且均達顯著性差異。
本研究結果支持TKR手術病人住院期間提供疼痛管理，對疼痛控制之成效具正向意義，因此，有系統的『疼痛管理』介入TKR術後病人之疼痛問題之處置，可以有效促進病人術後疼痛照護品質。

關鍵字

手術後疼痛 ； 疼痛管理 ； 全膝關節置換術

並列摘要

Pain is the first problem that patients will experience after surgery.According to the past studies, approximately 77% to 98% of postoperative patients experienced pain, of which 40% to 80% patients experienced moderate to severe pain,and at least 40% to 50% patients did not received adequate pain management.The purpose of this study was to compare the outcomes of “pain management procedure”：（1）increase pain attitude concept with postoperation pain,（2）decrease postoperation pain level,（3）increase pain management of satisfactions in total kneet replacement（TKR） patients.
This study pretest-posttest comparison research design was used .The patients received TKR procedure in the orthology inpatient wards at one medical center in Koashing.The treatment group included “the procedure of pain management”,the contral group did not. The following research instruments were used to measure the variables of pain management study:（1）pain Numeric rating scale,（2）patient's attitude concept scale,（3）patient's satisfaction with pain control, （4）and quality of the pain management with chart reviewed.The subjects were interviewed five times beginning a day before surgical,and postoperative First, second, third days up to a day before discharged.Data were analyzed by Chi-squaretest, pared t-test, independented t-test, One-way ANOVA with Repeat measurement.
A total sixty patients were recuited in this study：The results indicated:Two groups were homogenized, increase patient's attitude concept scale , decrease postoperation pain level, and increase Satisfaction level of the pain management . Siginificant differiences were found in the pain management group, which showed greater effects than in the control group.
The results strongly suggest that of the”pain management procedure” could increase satisfaction level of the pain management, pain attitude concept，and increase Satisfaction level in total knee replacement（TKR） patients.

並列關鍵字

Totol kneet replacement ； pain management ； postoperation pain

參考文獻

中文部分：

邱淑芬(1993)•探討有系統的術前護理指導對開胸手術病患手術後疼痛及身體功能恢復的影響•國立台灣大學護理學研究所碩士論文。

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林麗君(2002)•手術病患疼痛處置品質之探討•未發表之碩士論文，桃園：私立長庚大學護理學研究所。

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