病人及家屬對取消高血壓患者麻醉及外科手術的態度

Attitudes of the Patients and Their Families towards Cancellation of Anesthesia and Surgery in Hypertensive Patients

背景：手術前血壓過高，是將常規手術延後執行的常見原因之一，手術該不該被取消，往往不是單純醫學上的考量，如果能明瞭病患及其家屬對此議題的看法，可能幫助醫院建立有效率的品質管理系統，並增進醫療資源的使用。方法：在2003年初，針對一偏遠地區醫院的住院病人及其家屬，作面談式問卷調查，訪問他們對手術前高血壓及取消常規手術的態度。結果：總計有189人參與面談，因血壓過高而將常規手術取消的做法，超過42％的受訪者表示接受，差不多43％的人不認為取消手術會造成病人的損失，儘管受訪者大都認知到，血壓過高會加重外科手術的危險性，但只有不到12％的人，能接受手術後心血管合併症的發生，假如一旦發生合併症或造成損失，半數以上的受訪者認為，這是執行手術醫師的責任。結論：這鄉鎮地區病人及家屬，接受取消手術的人數，比接受術後心血管合併症發生的為多，建立一套取消高血壓病人麻醉及手法的標準處理模式，可能有助於減低醫療處置及管理上的差異性，並提高手術室的使用效率。

Background: Pre-operative hypertension which is a common cause for cancellation of scheduled surgery is not merely a medical consideration. Understanding the patients' and their families' attitudes towards this issue may help develop an efficient system of qualitative management and promote the utilization of medical resources in a hospital. Methods: Questionnaire of the study regarding the attitudes towards pre-operative hypertension and cancellation of scheduled surgery was answered through interviews by the patients and families admitted in a rural hospital in early 2003. Results: A total of 189 people were interviewed. Over 42% of interviewees said that cancellation of scheduled surgery in hypertensive patients was acceptable. Nearly 43% felt that such a cancellation did not cause any loss to patient. However, less than 12% of respondents could accept the occurrence of a post-operative cardiovascular complication as a reasonable event even though most of them acknowledged that a hypertensive patient was not a good risk for surgery. If any loss or complication occurred, more than half of them thought that it was the surgeon's fault. Conclusions: Most patients and families in this rural area accept case cancellation rather than tempt the suffering of a post-operative cardiovascular complication. Developing a standard guideline for postponement of anesthesia and surgery in hypertensive patients may help reduce the variability in practising and management, with resultant increase of operating suite efficiency.