行為提示對術後病患使用自控式止痛劑之影響

Effect of “Cueing” on Use of Patient-Controlled Analgesia after Operation

本研究目的在探討口語行為提示措施對術後病患之止痛劑消耗量、疼痛指數及顧慮程度之影響。本研究採類實驗研究法，以隨意取樣方式，在北部一所醫學中心選取81位肝膽腸胃外科病房之手術病患，其中實驗組41人，接受個別衛教與口語提示措施，控制組40人，僅接受個別衛教，5天後，再觀察兩組個案於術後使用止痛劑劑量、疼痛程度與顧慮程度的差異。研究所得資料以SPSS/Windows進行統計與分析。研究結果發現：病患接受口語提示措施後，可增加病患術後之嗎啡消耗量、降低病患每日平均疼痛指數及使用止痛劑的顧慮程度，其中顧慮項目中，病患於擔心成癮、轉移醫師對治療疾病本身注意力、止痛劑有一定施打時間與害怕產生耐藥性之項目上具顯著差異（P<0.05）；而控制組僅在好病人應避免談疼痛此顧慮項目的降低程度達統計上的差異。由此可知行為提示措施能有效改善術後病患使用止痛劑之劑量、疼痛程度與使用止痛劑之顧慮程度，為一值得推行之措施。

The purpose of this present study was to understand the effect of cueing post-operative patients to the use of patient-controlled analgesia(PCA) in controlling post-operative pain. Quasi-exporimontal design was used and purposive sampling was conducted at two general surgical wards of a medical center. Eighty-one sample subjects were randomly assigned into experimental and control groups. Subjects in both groups received an one to one, standard and systematic teaching program that focused on how to use the PCA correctly. A pamphlet regarding the safety of using PCA was also provided to each subject. The only difference between the experimental and control groups was subjects in the experimental group received six times standard active prompting that cued them to use the PCA within 48 hours after the operation. Findings from the study showed that effects of cueing patients to the use of PCA could significant increase the morphine consumption, decrease the intensity of pain and the worries to the use of analgesia: especially in 'fear of addiction', 'attraction for treatment', 'time for injection' and 'afraid of tolerance'. Results of this study suggested that the intervention of cueing patient to use PCA is not only an easy and time-saving nursing intervention, but also has strong effect on the use of analgesia.