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研究生:杜尚輯
研究生(外文):Shang-Chi Du
論文名稱:抽菸行為與手術後疼痛控制之回溯性研究
論文名稱(外文):The effects of smoking behavior on the acute painmanagement: a retrospective study
指導教授:葉淑娟葉淑娟引用關係
指導教授(外文):Shu-Chuan Yeh
學位類別:碩士
校院名稱:國立中山大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:63
中文關鍵詞:尼古丁手術術後疼痛止痛吸菸行為
外文關鍵詞:surgerypostoperative painanalgesicnicotinetobacco smoking
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根據過去國外研究指出抽菸行為會持續增加疼痛程度並且可能造成復原較差的風險,但也有文章指出尼古丁有止痛效果,這兩種說法造成臨床上的困擾。加上目前台灣所有醫院實施禁菸政策,造成許多抽菸病患突然戒菸,此一行為會引起戒斷症候群,也會改變病患急性疼痛行為及藥物止痛效果,本研究希望以一回溯性之方式,透過其他相關因子的資料蒐集與衡量,藉以探討及釐清急性術後疼痛控制和吸菸行為的關係。

本研究選取511位接受一般腹部手術患者,根據研究定義,將受試者分成二組:吸菸與不吸菸。從麻醉記錄及病歷資料包含手術部位、類型、手術時間資料、性別、年齡、體重、疾病史和手術後72小時的麻醉止痛劑和鎮靜安眠劑的用量。嗎啡的用量則透過病患自控式止痛設備來做紀錄。麻醉過程以標準流程處理,收集上述相關資料以進行研究後續之各因子之分析比較資料。排除重大心胸血管手術患者,神智不清患者,明顯肺部感染或腫瘤患者,及對嗎啡過敏患者。

研究結果顯示在感覺疼痛方面,吸菸組在第二天疼痛指數的疼痛程度顯著高於不吸菸組(p<0.001),指出吸菸病患明顯在手術後疼痛的感覺高於非吸菸組。而藥物止痛效果方面,吸菸組在第二天、第三天之止痛藥用量與總止痛藥用量則明顯高於不吸菸組(p<0.023),指出吸菸病患明顯在手術後止痛藥使用量
高於非吸菸組。吸菸與疼痛確實是有相關性的存在。
As some references suggested that tobacco smoking behavior increases the risk of persistent pain and poorer recovery, but some demonstrated that nicotine decreased pain sensitivity. Both contrary conclusions make clinicians confused on how to manage the patients with tobacco smoking habit. This study conducted a retrospective way to evaluate the relationship between acute postoperative pain management and tobacco smoking behavior.

This study included 511 Patients underwent general surgery were assigned to smokers or non-smokers. Site of surgery, type and duration of anesthesia were extracted from the anesthetic record. Information regarded each patient''s gender, age, preoperative weight, past medical
history, postoperative course, all non-opiate sedatives and opiate analgesics used in the first 72 hours were collected and recorded. Morphine administered via a patient-controlled analgesia (PCA) device was the preferred method of analgesia for these patients. Anesthesia was
standardized. Exclusion criteria included the patients underwent major thoracic cardiovascular surgery, the patients with significant lung lesion, the patients with conscious disturbance, and the patients with allergic history to morphine.

The results showed that of the sense of pain, the smoking group in the second day the pain scores significantly higher than non-smoking group (p<0.001), indicated that smoking patients were had more pain than non-smoking patients after surgery. And of the analgesic drug effects,
the smoking group in the second and third day analgesic doses and the total analgesic doses were significantly higher than non-smoking group (p<0.023), showed that smoking patients significantly used more analgesic than non-smoking group after surgery. Smoking was associated
with pain indeed existence.
目 錄
頁數
致謝詞............................................................ v
中文摘要........................................................ vi
英文摘要........................................................ vii
目錄................................................................ i
表目錄............................................................ iii
圖目錄............................................................ iv
第一章 緒論................................................... 1
第一節 研究背景與動機............................... 1
第二節 研究目的........................................... 2
第二章 文獻探討........................................... 3
第一節 吸菸人口分析................................... 3
第二節 吸菸行為對身體之影響................... 5
第三節 手術後疼痛之處理........................... 9
第四節 病患自控式止痛.............................. 14
第五節 抽菸與疼痛控制的相關研究.......... 17
第三章 研究設計與研究方法...................... 21
第一節 研究架構與假設.............................. 21
第二節 研究範圍.......................................... 23
第三節 研究流程.......................................... 23
第四節 變項的說明...................................... 25
第五節 資料分析.......................................... 27
第四章 分析與結果...................................... 28
第一節 描述性統計分析.............................. 28
第二節 推論性統計分析.............................. 31
第五章 結論與建議...................................... 43
第一節 討論.................................................. 43
第二節 研究限制與建議.............................. 45
參考文獻....................................................... 46
一、中文部份............................................... 46
二、英文部份............................................... 47
三、網頁部份............................................... 51
附錄 .............................................................. 52
附錄一 人體試驗計畫同意函 ..................... 52
附錄二 修改說明 ......................................... 53
參考文獻
中文部份:
1.台灣護理學會,(2009)。手術後疼痛臨床照護指引,財團法人國家衛生研究院_建立健保門、住、急診給付前十大疾病臨床指引計畫
2.王忠訓、周毅鵬、侯清正、李繼源、林炳煌、嚴復華,(1991)。胸腔切開處後病人自行控制與傳統止痛方式之比較,麻醉醫學雜誌,29(2),604-609。
3.王志中、何善台,(1995)。類鴉片藥物用於疼痛治療,疼痛醫學雜誌,5,93-106。
4.李蘭、潘怜燕,(2000)。台灣地區成年人之吸菸率與吸菸行為,中華衛誌,19期,423-36。
5.崔子軒,(2006)。探討不同止痛方式對病患手術後疼痛控制之成效-以南部某一區域醫院為例,國立中山大學醫務管理研究所未出版碩士論文。
6.陳國瀚,(1992)。手術後疼痛控制,臨床醫學,30 (1),1-6。
7.陳佩英,(1999)。住院癌症病患疲憊問題及其相關因素之探討,台北醫學大學護理學研究所未出版碩士論文。
8.楊銘欽、李玉春、劉嘉年等,(1992)。我國菸害經濟成本之研究,行政院衛生署。
9.賴志冠,(1999)。類鴉片鎮痛藥之合理使用,臨床醫學,43(1),33-39。
英文部份:
1.Acello B,(2000). Meeting JCAHO standards for pain control. Nursing, 30(3), 52.
2.Beaver WT, Feise GA, (1978). A comparison of the analgesic effect of intramuscular nalbuphine and morphine in patients with postoperative pain. Pharmacology and Experimental Therapeutics, 204, 487-96.
3.Benowitz NL, (1992). Cigarette smoking and nicotine addiction. Medical Clinics of North America, 76, 415-37.
4.Benowitz NL, (2008). Nicotine and postoperative management of pain. Anesthesia & Analgesia, 107, 739-41.
5.Christie MJ, Trisdikoon P, Chesher GB, (1982). Tolerance and cross tolerance with morphine resulting from physiological release of endogenous opiates. Life Sciences, 31, 839-45.
6.Creekmore F.M., Lugo R.A. and Weiland J, (2004). Postoperative opiate analgesia requirements of smokers and nonsmokers. Annals of Pharmacotherapy, 38, 949-953.
7.Chimbira W, Sweeney BP, (2000). The effect of smoking on postoperative nausea and vomiting. Anesthesia, 55(6), 540-4.
8.Carr ECJ,Thomas VJ,(1997). Anticipating and experiencing post-operative pain: the patients’perspective. Clinical Nursing, 6, 191-201.
9.Donovan BD,(1983). Patient attitudes to postoperative pain relief. Anesthesia Intensive Care, 11, 125-129.
10.Donovan M, Dillon P, McGuire L,(1987). Incidence and
characters of pain in a sample of medical-surgical inpatients. Pain, 30, 69-78.
11.De Conno F, Caraceni A, Gamba A, Mariani L, Abbattista A, Brunelli C, La Mura A, Ventafridda V, (1994). Pain measurement in cancer patients: a comparison of six methods. Pain, 57(2), 161-166.
12.Fertig JB, Pomerleau OF, Sanders B, (1986). Nicotine-produced antinociception in minimally deprived smokers and ex-smokers. Addict Behavior, 11, 239-48.
13.Jamison RN, Ross MJ, Hoopman P, Griffin F, Levy J, Daly M, Schaffer JL,(1997). Assessment of post-operation pain management: patient satisfaction and perceived helpfulness. Clinical Pain, 13, 229-236.
14.Jamner LD, Girdler SS, Shapiro D, Jarvik ME, (1998). Pain inhibition, nicotine, and gender. Clinical Psychopharmacology, 6, 96-106.
15.John, U., Hanke, M., Meyer, C., Volzke, H., Baumeister, S. E., & Alte, D, (2006). Tobacco smoking in relation to pain in a national general population survey. Preventive Medicine, 43(6), 477-481.
16.Koo A, Wong TM, (1983). Cross tolerance between morphine and beta-endorphin in the in vivo vasodilating effect in the hamster cheek pouch. Life Sciences, 32, 475-7.
17.Lantz PM, Jacobson PD, Warner KE, et al, (2000). Investing in youthtobacco control: a review of smoking prevention and control strategies. [Review] Tobacco control, 9, 47-63.
18.Miaskowski C. Donovan M, (1992). Implementation of the American pain society quality assurance standards for relief of acute pain and cancer pain in oncology nursing practice. Oncology Nursing Forum, 19, 411-415.
19.Pomerleau OF, Turk DC, Fertig JB. (1984). The effects of cigarette smoking on pain and anxiety. Addict Behavior, 9, 265-71.
20.Reiff PA, Niziolek MM. (2001). Troubleshooting TIPS for PCA. RN, 64(4), 33-37.
21.Silverstein B. (1982). Cigarette smoking, nicotine addiction, and relaxation. Social Psychology, 42, 946-50.
22.Schumann R, Shikora S, Weiss JM, Wurm H, Strassels S, Carr DB. (2003). A comparison of multimodal perioperative analgesia to epidural pain management after gastric bypass surgery. Anesthesia & Analgesia, 96, 469-74.
23.Turan A, White PF, Koyuncu O, Karamanliolu B, Kaya G, Apfel CC. (2008). Transdermal nicotine patch failed to improve postoperative pain management. Anesthesia & Analgesia, 107, 1011-7.
24.Ulf Jackobsson. (2008). Tobacco Use in Relation to Chronic Pain: Results from a Swedish Population Survey. Pain Medicine, 9(8), 1091-7.
25.Woodside JR. (2000). Female smokers have increased postoperative narcotic requirements. Addict Diseases, 19, 1-10.
26.Walder B, Schafer M, Henzi I, Tramer MR. (2001). Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain: A quantitative systematic review. Acta Anaesthesiologica Scandinavica, 45, 795-804.
網頁部分:
1.行政院衛生署國民健康局菸害防治資訊網,取自:
http://tobacco.bhp.doh.gov.tw/
2.WHO 菸草調查,取自:http://www.who.int/gho/tobacco/en/index.html
3.衛生署國民健康局,取自:http://www.bhp.doh.gov.tw/BHPnet/Portal/
4.行政院衛生署菸害申訴服務中心http://www.0800531531.com.tw
5.美國菸草與健康圖鑑《Tobacco Atlas》,取自:http://www.tobaccoatlas.org/
6.國家衛生研究院,取自:
http://www.nhri.org.tw/NHRI_WEB/nhriw2001Action.do?status=Show_Data&u
id=CA&mid=20081126544654820000&n_mk=0
7.國際疼痛研究學會,取自:
http://www.iasp-pain.org/AM/Template.cfm?Section=PAIN_
8. 行政院衛生署國民健康局菸害防治資訊網, 取自:
http://tobacco.bhp.doh.gov.tw/Show.aspx?MenuId=507
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