脊椎手術後疼痛控制－－必要時每四小時靜脈滴注Demerol之效果探討

Pain Control for Post-Spine Surgery Patients: A Survey of the Effectiveness of Demerol IV Drip Q4H prn

本研究目的是探討臨床上常見手術後疼痛藥物（pethidine iv drip q4h prn），對脊椎手術病患疼痛控制之效果及其影響因素。採描述性調查研究，研究對象為台北市某醫學中心接受脊椎手術之住院病患，採立意取樣法，總計收案47人。研究工具包括：VAS（Visual Analogue Scale）疼痛程度量尺、病患手術前止痛劑使用態度調查表、手術後疼痛調查表和手術後止痛劑使用記錄表。研究結果顯示：病患手術前對止痛劑使用之態度：64.4％病患預期手術後會有中度到嚴重程度的疼痛，88.2％病患希望止痛劑能解除大部分的疼痛，84.4％患者在疼痛加劇時最可能要求止痛劑，而85.2％病患希望在要求止痛劑時，能立即得到。手術後疼痛程度：手術後第一天63.8％覺得傷口中度以上疼痛，其中29.8％有嚴重疼痛，VAS所測得的平約疼痛得分為5.47分；手術後第二天59.6％中度以上疼痛，VAS得分4.74分；手術後第三天47.4％中度疼痛，VAS得分3.79分。女性病患VAS得分顯著高於男性。研究結果可作為臨床醫護人員手術後疼痛處理之參考。

The purpose of this study was to explore the effectiveness of clinical pain medicine (pethidine q4h prn) for patients with spinal surgery and its related factors. A descriptive study design was used. We used a preoperative patients' attitudes to pain questionnaire, a postoperative pain questionnaire and a Visual Analogue Scale (VAS) to collect data from patients undergoing spinal surgery. Forty-seven subjects were chosen from a medical center in the metropolitan Taipei by convenience sampling. Descriptive analysis and one-way ANOVA were used for statistical analysis. The results were as follows: (1) The patient's attitudes to pain preoperatively: 64.4% expected moderate to severe pain. 88.2% wanted the medicine to give them a lot of relief. 84.4% would ask for medicine when pain became severe. 85.2% expected pain medication to be given immediately if they asked for it. (2) The patients' pain levels postoperatively: During the first 24 hours, 63.8% had more than moderate pain, and 29.8% had severe pain. VAS score was 5.47. During the second day, 59.6% had more than moderate pain. VAS score was 4.74. During the third day, 47.4% had moderate pain. VAS score was 3.79. (3) Female patients had more pain than male patients. The results could be used by clinical nurses in postoperative pain management.