臺灣博碩士論文加值系統

背景：
隨著生活條件的改善與醫療技術的進步，越來越多的老年患者接受手術並且需要外科加護病房包括良好止痛的術後照顧。我們的目的，是希望找出在外科加護病房裡面針對術後老年患者，比較好的急性疼痛控制方式。

方法：
一個擁有26床外科加護病房的北部醫學中心，收集從2011年4月至2012年9月的病歷，以審查病歷方式做回朔性研究。患者排除標準如下：術後第一天無意識，不合作，小於65歲，腦部手術術後，美國麻醉醫師協會分類< III。主要目的是比較在三種不同狀況下，使用三種不同術後止痛方式患者之疼痛指數。次要目的是患者滿意度及影響患者滿意度的決定因素。

結果：
有580例符合條件，平均年齡為76歲，男性佔57％。在休息的狀況下，與其他兩組相比，患者自控式硬脊膜外止痛(PCEA)組的疼痛指數較低（12.06±9.53）。在移動的狀況下，患者自控式硬脊膜外止痛(PCEA)組和健保給付止痛(Pethidine/NSAIDs) 組無差異; 兩組患者疼痛指數均低於靜脈患者自控式止痛(PCA)組（41.38±12.5）。
在咳嗽的狀況下，健保給付止痛(Pethidine/NSAIDs) 組較另兩組自控式止痛組的疼痛指數低（39.67±24.50）。患者自控式硬脊膜外止痛(PCEA)組的患者滿意度最高（4.27±0.51）。逐步多元線性回歸分析顯示，使用患者自控式硬脊膜外止痛(PCEA)與患者的滿意度有正相關，而T-piece的使用有負相關。

結論：
患者自控式硬脊膜外止痛(PCEA)是一個對於在外科加護病房內老年患者急性疼痛比較好的止痛控制選擇。

Background:
With technological advancements, more elderly patients are undergoing surgery and require care from surgical intensive care units. We aimed to determine the pain management method that provides better acute pain control in all-cause elderly surgical intensive care unit patients.

Methods:
This retrospective cohort study included a chart review of patients treated in a 26-bed surgical intensive care unit from April 2011 through September 2012. The patient exclusion criteria were as follows: unconscious, uncooperative, <65 years, post-brain surgery, or had an American Society of Anesthesiologists classification <III. The primary aim was to compare visual analogue scale (0–100) scores between three different methods of pain management. The secondary endpoints were patient satisfaction and determinants of patient satisfaction.

Results:
We evaluated 580 patients. The average age was 76 years, and 57% were male. At rest, the patient-controlled epidural analgesia group exhibited significantly lower pain scores (12.06±9.53) compared with the other two groups. During movement, the patient-controlled epidural analgesia and pethidine/nonsteroidal anti-inflammatory drugs groups showed no difference; both exhibited lower pain scores than the patient-controlled analgesia group (41.38±12.5). While coughing, the pethidine/nonsteroidal anti-inflammatory drugs group exhibited lower scores (39.67±24.50) than the patient-controlled epidural analgesia and patient-controlled analgesia groups. The patient-controlled epidural analgesia group showed highest patient satisfaction (4.27±0.51). Stepwise multiple linear regression analysis revealed that patient satisfaction was associated with patient-controlled epidural analgesia (positively) and T-piece trial (negatively).

Conclusion:
Patient-controlled epidural analgesia appears to be a better choice for acute pain management for all-cause elderly surgical intensive care unit patients.

目錄
誌謝……ⅰ
中文摘要……ⅱ
英文摘要……ⅳ
目錄……ⅵ
圖目錄……ⅶ
表目錄……ⅷ
第一章 序論……01
第一節 研究動機與背景……01
第二節 研究目的……03
第二章 研究設計……04
第三章 研究的分析方式……07
第四章 實證研究成果……07
第五章 討論……10
第一節 統計結果分析（患者自控式硬脊膜外止痛VS.健保給付止痛）……10
第二節 成本效益（患者自控式硬脊膜外止痛vs.靜脈患者自控式止痛）……11
第三節 次族群（癌症患者）研究成果……12
第四節 影響因子……13
第五節 研究的限制……13
第六章 結論……14
參考文獻……15

圖目錄
圖1. 三種不同術後止痛方式的患者平均滿意度……19

表目錄
表1. 患者基本特徵……20
表2. 三種不同的狀況下使用三種不同術後止痛方式患者之VAS疼痛指數……22
表3. 患者滿意度的決定因素……23
表4. 三種不同的狀況下使用三種不同術後止痛方式癌症患者之VAS疼痛指數與滿意度……24

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