探討骨科患者內固定復位手術前後焦慮感及其相關因素之研究

To Explore the Related Factors of Anxiety of Orthopedic Patients before and after Reduction Internal Fixation Surgery

焦慮感是影響病人在疾病、治療及住院經驗中，身體機能復原過程的一個重要因素。當病人面臨住院接受手術治療時，會產生不同程度的焦慮感受，進而影響疾病的預後、或病人的生理及心理之健康狀況，若能瞭解其影響因素將有助於減輕病患的不適，進而改善身心狀況及促成良好的預後和功能恢復。本文依立意取樣方法並經由長期追蹤方式收集研究個案，研究對象為屏東縣某家地區醫院施行內固定復位手術之骨科患者，分別於手術前及手術後以結構式問卷進行調查，施測問卷包括骨科患者人口學特性與情境－－特質焦慮量表，總計收取有效樣本80人。研究結果顯示，(1)患者手術前處於高度情境焦慮平均60.86分，手術後下降為輕度焦慮平均39.71分，下降21.15分且達統計上顯著降低（t-23.71, p <001 )。(2)患者在手術前特質焦慮程度為中度平均44.31分，手術後改善為輕度均為39.26分，降低5.05分且達統計上顯著降低（t-5.88, p<001 )。(3)手術前後情境焦慮得分降低量分析方面，在手術前有運動習慣患者平均降分量達22.00分，無運動習慣患者平均降分量為18.42分，說明在術前有運動習慣者較高量的降分情況且達顯著差異(t=-2.10, p=.039)(4)在手術前後特質焦慮得分降低量分析方面，在手術前無骨科住院經驗患者平均降分量達6.21分，有骨科住院經驗患者平均降分量為1.32分，說明在術前無骨科住院經驗患者有較高量的降分情況且達顯著差異(t=2.17, p=.048)。本研究結果可協助骨科醫護人員瞭解接受內固定復位手術前後患者焦慮感之變化情形，可作為醫護人員，照護內固定復位手術病人時之參考，進而提升醫療與護理照護品質。

Anxieties of patients were important factors for recuperating at hospital. The different levels of feeling of anxieties from patients during surgery would influence their prognosis of the disorder or their health in physiology and psychology. Therefore, we should study how to improve the anxieties from patients, and then, we can reduce their disorder from illness and improve their health in physiologically and psychologically. The longitudinal study design would be used to explore the related factors of anxiety of eighty orthopedic patients before and after reduction internal fixation surgery by collecting the questionnaires, which were included demographic characteristics and State-Trait Anxiety Inventory (STAI). The results showed that (1) the average score of State-Anxiety of patients reduced by 21.15 points, when compared to the average score of State-Anxiety of patients before (60.86 points) and after (39.71 points) reduction internal fixation surgery, and it was significant in statistic (t=-23.71, p < .001); (2) the average score of Trait-Anxiety of patients reduced by 5.05 points, when compared to the average score of Trait-Anxiety of patients before (44.31 points) and after (39.26 points) reduction internal fixation surgery, and it was also significant in statistic (t=-5.88, p <.001); (3) when comparing the reductions of the average scores of State-Anxiety of patients before and after reduction internal fixation surgery, the reductions of the patients exercised regularly were 22.00 points better than those did not exercise regularly 18.42 points for the average score of State-Anxiety, and it was significant in statistic (t=-2.10, p=.039); and (4) when comparing the reductions of the average scores of Trait-Anxiety of patients before and after reduction internal fixation surgery, the reductions of the patients hospitalized for orthopedic surgery were 6.21 points better than those never been hospitalized for orthopedic surgery 1.32 points for the average score of Trait-Anxiety, and it was significant in statistic (t=2.17, p=.048). Finally, this study can be helpful in realizing the variations of anxiety of the patients before and after reduction internal fixation surgery; and to find and explore its relative factors. It also can be used as a reference resource in improving the quality of taking care of orthopedic patients for the clinicians and the nurses.