南台灣某大學附設醫院的急性疼痛控制服務之追溯性分析

Retrospective analysis of patient-controlloed Analgesia service at auniversity hospital in south Taiwan

病患自控式止痛（PCA）自百元兩千年引進我們的醫院，急性疼痛控制服務團隊也同時成立來改善病患自控式止痛的品質以及效能。PCA的配方主要包含了靜脈注射式嗎啡PCA（IVPCA）以及硬脊膜外腔式嗎啡PCA（PCEA）。三年來由急性疼痛服務團隊收集了人口統計上，PCA的給藥路徑，止痛的效能（由VAS量表來評估）•PCA的相關副作用以及病患的滿意度的相關資料，我們分析了這些資料。結果：我們醫院的急性疼痛服務團隊三年來提供了2514位自控式止痛（2001“2003）。使用PCA的病患人數佔手術病患的比例由2001年的5.98%增加到2003年的7.04%。在全部2514位病患的研究中，全面性的止痛效能是極優良的（VAS的分數由術後第一天至第三天有明顯的降低）。在我們的觀察中，鴉片類藥物引起常見的副作用包括術後的噁心、嘔吐、搔癢、頭昏眼花、困倦以及尿滯留。另外僅有少數的副作用例如兩位呼吸抑制、一位視幻覺、一位精神錯亂、一位耳鳴以及一位被視。全面性的病患滿意皮是84.64罩。在滿意度的分析上，其中主要引起不滿意的因子包含了疼痛消除的不足、搔癢、嚴重的術後噁心嘔吐以及PCA機器警報聲。PC臥在發生副作用的人數上明顯低於IVPCA但是在止痛皮及滿意度上，PCEA和IVPCA並無明顯的差異。結論：PCA在高醫大醫院應用的初步成效是非常良好。PCA對於病患的手術後疼痛控制以及醫療品質均有明顯的提升。然而，在有效降低PCA的副作用（術後噁心嘔吐、搔癢）以及提高PCA的安全性和品質也是我們努力的目標。

Patient-controlled analgesia (PCA) was introduced to postoperative patients at our hospital since 2000 A.D., meanwhile an Acute Pain Service(APS) team was also established to enhance efficiency and quality of PCA. Our PCA regimens included mainly morphine IVPCA, morphine PCEA. We collected demographic, route for PCA, analgesia efficiency( evaluated by VAS score), PCA related complications and patients' satisfaction of PCA( evaluated by visual analogue rating scales completed by patients). Results : Our data revealed the increasing annual number of postoperative PCA using from 5.98 % in 2001to7.04% in 2003. Among the 2514 patients in our study, the overall analgesia efficiency was excellent (VAS significant decreased from first day to third day). In our observation, common opioids related side effects included PONV, pruritis, dizziness, drowsiness and urinary retention; there were few complications such as two respiratory depression, one visual hallucination, one delirium, one tinnitus and one diplopia. The overall satisfaction rate was 84.64%. In our analysis of satisfaction, there were several major unsatisfied factors such as inadequate pain relief, pruritis, severe PONV and PCA pump alarming. PCEA showed significantly lower side effects than IVPCA (nausea : IVPCA : PCEA = 14.20% : 2.04% , P > 0.05) (pruitus : IVPCA: PCEA= 9.85% : 1.02% , P> 0.05), but there no was significant difference between IVPCA and PCEA in analgesia and satisfaction in our investigation. Conclusion : We had got primary good results in recent years. Our promotion of PCA did benefit more patients suffered from postoperative pain, enhanced, medical quality and achieved the goal to decrease postoperative pain. However, it still needs our effort to minimize PCA complications such as PONV, pruritus for higher PCA safety and quality we can offer.