研究背景:手術後的急性疼痛管理是醫護人員的重要照護目標,若病人的疼痛不能有效的減緩,其心理和生理產生不良作用,也會延遲傷口癒合,改變免疫功能和增加壓力,進而導致生理和心理功能均受影響以及增加健康照護的成本。 目的:本研究探討疼痛控制的使用是否影響手術住院的醫療利用。 方法:採回溯性研究,對象為某醫學中心接受「腹部全子宮切除」手術之772 位病患。以病歷審查方式收集病患的人口學特質、疾病史、手術情形、術後疼痛處置、回診次數,醫療利用則為病患住院日數及醫療費用。應用複迴歸分析探討疼痛控制之使用對手術住院的醫療利用之相關因素。 結果:在控制其他變項之後,「是否為惡性腫瘤」、「術後是否有合併症」、「ketorolac 劑量」、「嗎啡劑量」、「手術時間」皆與住院日數呈顯著正相關;而「每日每公斤平均嗎啡劑量」則與住院日數呈現顯著負相關。與住院總費用呈現顯著正相關之因素包含「是否為惡性腫瘤」、「術後是否有合併症者」、「手術時間」、「嗎啡劑量」,而「糖尿病」、「是否使用PCA」、「每日每公斤平均嗎啡劑量」、以及「主治醫師年資」則與住院總費用呈現顯著負相關。 結論:對於腹部子宮全切除手術,使用PCA 不會影響住院日數,但卻可減少醫療費用,疼痛控制之劑量對於住院日數與醫療費用有顯著正相關。
Background A major goal of surgical nursing care is effective pain management of patients after surgery. If the pain couldn’t be relieve effectively, it would result in the patients’ physical and mental problems. Also, the unresolved pain would prolong healing wound, change the immune system and increase pressure. Furthermore, it might influence the patients’ physical and mental function and increase the cost of health care. Objective: The topic of the thesis is about if the use of pain control affects the utilization of hospitalization. Method: The research adopts the method of “retrospective study.” The objects are the 772 patients who underwent the surgery of abdominal total hysterectomy by certain hospital. With the investigation of patients’ cases history, we collected those patients’ demography traits, their history of disease, the situation of surgery, the pain management of postoperation, and the times of outpatient service. And the total fees in hospital includes the length of hospital stay and the fees of medical treatment. Furthermore, we apply the method of “multiple-regression-analysis” to analyze how the pain control influence the utilization of hospitalization. Result: After controlling the other variables, we found that the following matters are positive correlative to the length of hospital stay -"whether a malignancy or not,”“whether a postoperative complication,” “the ketorolac dose,” “the morphine dose,” and “the duration of surgery.” On the other hand, “the average morphine dose per day per kilometer” is negative correlative to the length of hospital stay. The factors that are positive correlative to the total fee of hospitalization include –“whether a malignancy or not,” “whether a postoperative complication,” “the duration of surgery,” and “the total morphine dose.” On the other hand, the “diabetes,” “whether uses PCA,” “the average morphine dose per day per kilometer, and “the seniority of attending physican” are negative correlative to the total fee of ospitalization. Conclusion: Using the PCA for the abdominal total hysterectomy wouldn’t influence the length of hospital stay; however, it could decrease the fees for medical treatment. Furthermore, the dose of pain controlling is positive correlative to the length of hospital stay and the fee of health service.
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