探討不同給藥方式對脊椎手術病患疼痛控制之成效

Comparison the Effectiveness of Different Pain Analgesia Provision for Spine Surgery Patients

本研究採準實驗設計，探討脊椎手術病患手術前對止痛劑使用態度及三種疼痛處理方式對脊椎手術病患疼痛控制之效果。以立意取樣法共收案135人，第一組meperidine q4h iv prn 47人'第二組meperidine iv q4h 46人、及第三組morphine PCA 42人。研究工具包括疼痛分類量表、VAS疼痛程度量尺、病患手術前對止痛劑使用態度調查表及手術後疼痛程度問卷調查表。統計方法包括描述性分析、卡方考驗、單因子變異數分析等。研究結果：1.手術前64.4%病患預期手術後會有中度到嚴重程度的疼痛，88.2%希望止痛劑能解除大部分疼痛，84.4%在疼痛加劇時最可能要求止痛劑，85.2%病患期望要求止痛劑時，能立即得到。2.三組間疼痛程度有顯著差異，第一組感覺最痛，63.8%覺得是中度以上疼痛，第二組與第三組之疼痛控制效果無顯著差異，但均優於第一組。研究結果可作為臨床醫護人員疼痛處理之參考，提供病患更好的手術後疼痛照顧。

This study, a quasi-experiment, was designed to evaluate the effectiveness of patients undergoing spine surgeries in response to pain control medications. The primary purpose was to evaluate the patients' preoperative attitude toward the use of analgesics and analyze the effects of three different pain control methods on their analgesic efficacy. Purposeful sampling was used: 47 patients in group I received meperidine q4h prn iv injection; in Group II, 46 patients were given meperidine iv injection every four hours; and in Group III, 42 patients were given patient-controlled analgesics (PCA). VAS pain scale and structural questionnaires were used to collect data. For statistical analysis, descriptive statistics, Chi-square analysis, oneway ANOVA were used. The results showed that: (1) Prior to surgery, 64.4%ofthe cases predicted that there would be moderate to sever pain after operation. Of these patients, 88.2% wished that the pain could be relieved by analgesics, and 84.4% would take analgesics when the pain was intolerable or exacerbated. 85.2% of the patients demanded that the analgesics be given immediately while asked for it. (2) The postoperative pain severity was the highest on post-op day I, and the severity decreased gradually with time. Group I patients had the highest pain scores, with 63.8% of them complaining of moderate or severe pain. Statistical analysis showed that there were significant differences between Groups I and II, but not between Groups II and III. These results demonstrated that the choice of analgesics administration methods could significantly affect pain control.