- 學位論文
日間門診手術病患執行快速通道麻醉健康療效之探討
Health Outcomes In Ambulatory Surgery Patients After Fast-Track Anesthesia
摘要
目的：病患出院後24小時，利用調整版功能問卷 ( Modified 24H Functional Ability Questionnaire)針對日間門診手術執行快速通道麻醉之病患，探討快速通道麻醉介入措施，對病患健康療效的影響及其影響因素。 研究方法：本研究以南部某醫學大學附設醫院接受無痛內視鏡檢查、手術及婦產科子宮括除(Drainage & Curettage)、切片、切除、超音波陰道取卵 ( Echo-guided Oocytes Retrieval)、Loop Electrosurgical Excision Procedure(LEEP)及其他科等微小手術之日間門診手術病患執行監視麻醉(Monitored Anesthesia Care)，共82位為研究對象，個案收集時間為2008年12月至2009年3月。本研究旨在探討介入快速通道概念 ( Fast-track Concept ) 及快速通道麻醉流程 ( Fast-track Protocol)，追蹤與評估麻醉後快速通道組與傳統組病患之健康療效，屬於橫斷性研究設計(Cross- sectional Study Design)。 成效評估：日間門診手術病患，於手術後利用快速通道評值表評分 ( White’s Fast-track Scoring System)，選擇快速通道評值分數≧12之個案，奇數病患為傳統組(Conventional Group)；偶數病患為快速通道組 (Fast-track Group)；出院後24小時使用問卷電訪。利用SPSS 12.0統計套裝軟體，分析快速通道組與傳統組病患兩者間之健康療效；即麻醉恢復時間、生活品質、認知及滿意度是否有差異。 研究結果：快速通道組與傳統組兩組病患在麻醉恢復時間(P<0.001)及生活品質(P<0.05)有顯著性差異；但兩組病患在認知及滿意度沒有顯著性差異。 結論：日間門診手術病患手術後利用快速通道評值表評分，符合快速通道評值分數≧12之個案，可繞過麻醉後恢復照護單位(Postanesthetic Care Unit，PACU)，即 日間門診微小手術執行快速通道之措施，繞道麻醉恢復照護單位 ( PACU Bypass Area)是可行的。
並列摘要
Objective: To evaluate the effects and the impact factors on health outcomes in ambulatory surgery patients after fast-track anesthesia using the modified 24 hour functional ability questionnaire (Modified 24H FAQ) when patients discharged home 24 hours laterly. Methods: Total 82 ambulatory surgery patients performed at a teaching hospital in Southern Taiwan under stress free endoscope , gynecological surgery such as cervical D&C , biopsy, excision , echo- guided vaginal oocytes retrieval , loop electrosurgical excision procedure (LEEP ) and other minor surgery were included. All cases scheduled from December/2008 to March /2009 under monitored anesthesia care (MAC ) were collected .The aim of thesis was to evaluate health outcomes between fast-track group and conventional group in ambulatory surgery patients after fast-track concept & protocol implement. The study belongs to cross sectional study design. Main outcome measurement : Ambulatory surgery patients were evaluated by using White’s fast-track scoring system at the end of surgery. With the White fast-track score greater than or equal to 12﹐odd number cases were selected into our study design as conventional group and even number cases as fast –track group. Questionnaires were interviewed through the phone call and data collection and analysis in health outcomes including anesthetic recovery time﹐quality of life , perception and satisfaction between fast-track group and conventional group by using SPSS12.0 software. Result: There were significant differences in anesthetic recovery time (P value <0.001) & quality of life (P value<0.05) between fast-track group and conventional group, but there were no significant differences in perception and satisfaction. Conclusion: Ambulatory surgery patients with postanesthetic White’s fast-track score greater than or equal to 12 would possibly bypass the conventional postanesthetic care unit (PACU) into the access of fast-track anesthesia. The development of the PACU bypass area would be feasible for those ambulatory surgery patients under fast-track anesthesia.
參考文獻
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