病患自控式止痛對疼痛感受與睡眠品質調查研究 -以膝關節置換手術為例

Research About The Effect Of Patient-Controlled Analgesia(PCA)To The Pain Perception And Sleeping Quality — Taking Knee Replacement Surgery For Example

劉慧君(HUI-CHUN LI)

指導教授 ： 洪錦墩

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2020年)

摘要

目的：疼痛管理成效是護理品質的重要指標，提升病人滿意度及睡眠品質是手術後護理照護的良好成效指標。本研究目的在瞭解手術病患自控式止痛對疼痛感受與睡眠品質改善之成效。
方法：以2019年某地區醫院20歲以上採自控式止痛者81位膝關節置病患為研究對象，以訪員進行結構式問卷收集其術後3天疼痛控制滿意度與維辛式睡眠量表之睡眠品質。
結果：膝關節置換手術病人使用PCA：女性85.2%，以女性占居多。個案年齡66-87歲82.7%，以66-87歲占居多。教育程度方面，小學(含以下) 77.8%，以小學(含以下)占居多。子女方面：有子女97.5%，以有子女占居多。手術經驗方面：有手術經驗80.2，以有手術經驗占居多。麻醉方式方面：有半身麻醉90.1%，以有半身麻醉占居多。以24小時感覺到最痛的程度為8.88±1.13，術後48小時為5.35±2.31，均屬中重度疼痛程度。睡眠品質之影嚮睡眠干擾第一天中度疼痛平均值為61.88± 2.34較重度疼痛平均值為46.14± 9.55，分數愈高，疼痛指數中度較重度睡眠愈不受擾，t值為2.83（p =0.006； p<0.01）；睡眠干擾第二天中度疼痛平均值為64.96±13.98較重度疼痛平均值為47.73±12.20，分數愈高，疼痛指數中度較重度睡眠愈不受擾，t值為2.39（p =0.019； p<0.05）僅於第1天與第2天的不受干擾達顯著之差異，餘第3天的之不受干擾、及1-3天內有效睡眠及補足睡眠或整體睡眠品質，無顯著之差異。顯示民眾在術後傷口疼痛會延長病人睡眠潛伏期影響病人入睡，易使睡眠中斷而醒來，給予自控式止痛會因預期會痛而按壓機器，造成病人早晚昏睡過多，反而導致晚間有睡不著之狀況。
結論：護理人員應協助自控式止痛病人作最好的止痛控制，除減輕病人的疼痛不適感，若能同時協助改善其睡眠品質，更有助於病患之生活品質。

關鍵字：病患自控式止痛、數字等級量表（NRS）、睡眠品質

關鍵字

病患自控式止痛 ； 數字等級量表 ； 睡眠品質

並列摘要

Abstract
Objective: The effect of pain care is an important indicator of nursing quality. To improve the satisfaction and sleeping quality of patients during the postoperative nursing care. The objective of this research is to understand the effect of patient-controlled analgesia (PCA) to the pain perception and sleeping quality improvement.

Methods: To take 90 patients over 20 years old with knee replacement surgeries in a regional hospital in 2019 as subjects. Dividing these subjects to patient controlled analgesia (PCA) and non-PCA for comparison. To collect structured questionnaires about the satisfaction of pain controling and Verran and Snyder-Halpern Sleep Scale (VSHSS) about the sleeping quality from these patients 3 days after surgeries.

Results: Knee replacement patients were satisfied with PCA. The majority are women (85.2%). Most people are around 66-87 years old (82.7%). In terms of education, 77.8% of patients got primary schools (or below) diploma. In terms of family situation, 97.5% of them have children. In terms of surgery experience, 80.2% of them had surgery experience, while in terms of anesthesia experience, 90.1% of them had regional anesthesia experience. The most painful feeling in 24 hours is 8.88 ± 1.13, while in 48 hours after surgery is 5.35 ± 2.31, which are moderate to severe pain. In terms of sleeping quality, the average index of sleeping disturbance due to the moderate pain on the first day of surgery is 61.88± 2.34, while the severe pain is 46.14 ± 9.55. The index shows that patients got less sleeping disturbance with moderate pain than severe pain, and the t value is 2.39 (p =0.019; p<0.05.) There was a significant difference in undisturbed only on the first day and the second day, and there was no significant difference in undisturbed and effective sleep and supplementary sleep or overall sleep quality in the remaining 1-3 days. This shows that postoperative wound pain will prolong the patient's sleep latency and affect the patient to fall asleep, and it is easy to wake up when the sleep is interrupted. The self-controlled analgesia will press the machine because it is expected to cause pain.

Conclusion: Nursing staff should assist PCA for better pain controlling to relief the discomfort of patients. If this help with the improvement of sleeping quality meanwhile, this will be more helpful with the living quality of patients.

Key words: Patient Controlled Analgesia (PCA), Numerical Rating Scale (NRS), sleeping quality

並列關鍵字

Patient Controlled Analgesia (PCA) ； Numerical Rating Scale (NRS) ； Sleeping Quality

參考文獻

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