不同麻醉方式用於痔瘡及肛門瘻管手術後疼痛及併發症相關性之探討

Correlation between postoperative pain and complica-tions of hemorrhoids and anal fistula in different anes-thesia methods

趙玉婷(Yu-Ting Chao)

指導教授 ： 羅英瑛

義守大學/醫學院/醫務管理學系/碩士(2020年)

摘要

研究目的：本研究在探討痔瘡及肛門瘻管手術後的病人，比較全身麻醉，脊髓麻醉及脊髓麻醉加入鞘內嗎啡三組在疼痛控制、麻醉合併症、住院天數相關性。
研究方法：採回溯性研究設計，將 2018 年 1 月至 12 月，在南部某準醫學中心實施痔瘡及肛門瘻管手術者，查詢醫療資訊系統所登錄之資料，以 Excel 整理資料 SPSS軟體統計，進行分析。
結果：收案 203 人，男性 128 人(63.1%)，女性 75 人(36.9%)；手術麻醉方式使用脊髓腔內嗎啡減痛法者 Intrathecal morphine(ITM)24 人(11.8%)、全身麻醉 92 人(45.3%)、脊髓麻醉 87 人(42.9%)。在合併症方面方面，有術後噁心嘔吐 13 人(6.40%)、有皮膚搔癢 25人(12.32%)、有尿滯留 3 人(1.48%)、有眩暈 13 人(6.40%)，平均住院天數則是住4 天最多，占(45.8%)，在麻醉方式的止痛效果，ITM 的止痛效果優於全身麻醉及脊髓麻醉，在合併症方面，ITM 在術後噁心嘔吐和皮膚搔癢發生的機率高於全身麻醉及脊髓麻醉，三種麻醉方式在住院天數上則無顯著差異。
結論與建議：發現脊髓腔內嗎啡減痛法在三種麻醉方式相較之下手術後止痛效果最好，但在發生皮膚搔癢與術後噁心嘔吐的合併症的機會是高於其他兩種麻醉方式。若是希望讓病患在手術後得到健全的疼痛照護有較佳的手術經驗，脊髓腔內嗎啡減痛法手術是較佳的方式。另建議採用事先預防的方式來降低採用此這麻醉方式而產生的術後合併症帶來的不適感或是臨床照護上的負擔。

關鍵字

麻醉方式 ； 肛門瘻管 ； 術後疼痛控制

並列摘要

Research purpose：This study is to investigate the correlation between general, sp inal and spinal anesthesia and intrathecal morphine in patients after hemorrhoids and a nal fistula surgery in pain control, anesthesia comorbidities, and length of hospital stay.
Research method：A retrospective research design was adopted to perform hemorr hoids and anal fistula surgery in a quasi-medical center in the south from January to December 2018, query the data registered in the medical information system.
Results：203 people were admitted, 128 males (63.1%), 75 females (36.9%); 24 people (11.8%) who used intrathecal morphine (ITM) for pain reduction in spinal anes thesia and 92 general anesthesia People (45.3%), 87 people (42.9%) with spinal anesth esia. In terms of comorbidities, 13 people had postoperative nausea and vomiting (6.4 %), 25 people had itchy skin (12.32%), 3 people had urine retention (1.48%), and 13 people had dizziness (6.40%). The average length of hospital stay was Live for 4 day s is the most, accounting for (45.8%). In terms of the analgesic effect of anesthesia, t he analgesic effect of ITM is better than general and spinal anesthesia. In terms of co mplications, ITM has a higher probability of postoperative nausea, vomiting and skin i tching. For general anesthesia and spinal anesthesia, the three anesthesia methods had no significant difference in the length of hospital stay.
Conclusions and recommendations：It was found that the spinal cord morphine p ain reduction method has the best analgesic effect after the operation compared with t he three anesthesia methods, but the chance of complications of skin itching and post operative nausea and vomiting is higher than the other two. If you want to allow pati ents to receive sound pain care after surgery and have a better surgical experience, int ra-spinal morphine pain reduction surgery is the better way. It is also recommended to
use pre-prevention methods to reduce the discomfort caused by postoperative complic ations or the burden of clinical care caused by this anesthesia method.

並列關鍵字

anesthesia ； anal fistula ； postoperative pain control

參考文獻

中文部份

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