臺灣博碩士論文加值系統

背景：全球美容整形手術的數量每年已經超過一千萬件，以隆乳手術為大宗。此類手術為非必要，因此病患對整體醫療照護品質要求較一般手術為高，其中手術後恢復品質為一重要指標。全身麻醉方式可能對手術後恢復品質有所影響，但目前為止相關研究多著重於技術與儀器、行銷，對於手術後病患的照顧品質反而鮮少人重視，相關學術研究更是為數不多。
目的：本研究針對經腋下內視鏡隆乳手術病人，以15-item Quality of Recovery Score (QoR-15)評估不同全身麻醉方(吸入性麻醉或完全靜脈麻醉)對手術後恢復品質是否有影響。
方法：本研究為前瞻性平行對照隨機控制試驗，共納入符合條件病患共104人，隨機分至吸入性麻醉組與完全靜脈麻醉組，收集病患個人屬性與手術相關因素資料，並且以QoR-15於手術後一天及第二天進行手術後恢復品質自評。所得資料進行統計分析。
結果：兩組間在年齡、性別與身體質量指數三項皆無統計差異(p > 0.05)。手術相關因素中，完全靜脈麻醉組病患需使用止吐藥比率顯著低於吸入性麻醉組病患 (23.1% vs. 53.6%，p = 0.002)。於手術後第一天，吸入性麻醉組與完全靜脈麻醉組病患的平均QoR-15總分分別118.9 (標準差21.3)與118.5 (標準差20.0)，兩組間無顯著統計差異(p = 0.921)。於手術第二天，吸入性麻醉組與完全靜脈麻醉組病患的平均QoR-15總分仍無顯著統計差異(p = 0. 960)。複迴歸分析結果顯示，無論是針對手術後第一天或是第二天的恢復品質QoR-15總分，全身麻醉方式皆沒有顯著影響，僅有身體質量指數有顯著正向影響。
結論：本研究顯示對於接受經腋下內視鏡隆乳手術的病患，其全身麻醉方式不論為吸入性麻醉抑或完全靜脈麻醉，對手術後第一天與第二天的恢復品質皆沒有顯著影響。於整形外科診所進行經腋下內視鏡隆乳手術時，只要病人本身生理狀況良好，再輔以適當的手術與麻醉照護， 吸入性麻醉與完全靜脈麻醉這兩種全身麻醉方式都是合宜的，可依手術室配備、整形外科醫師與麻醉醫師習慣或偏好、病人需求或偏好擇其一，均能安全無虞，並於手術後第一天達良好恢復狀況。

Background: The number of aesthetic plastic surgery is more than ten million per year globally, and breast augmentation is one of the major procedures. Since the elective nature, the quality of care was requested higher than overall surgery. The types of general anesthesia may affect the quality of recovery, which is one of the important factors of the quality of care. However, there are few studies focusing on the quality of postoperative recovery.
Object: To evaluate the effect of the type of general anesthesia on quality of postoperative recovery in patients undergoing transaxillary endoscopic breast augmentation.
Methods: This prospective, parallel, randomized controlled study enrolled eligible 104 patients who underwent transaxillary endoscopic breast augmentation. These patients were randomly assigned to inhalation anesthesia group (n=52) or total intravenous anesthesia group (n=52). The baseline demographic and clinical characteristics were collected, and 15-item Quality of Recovery Score (QoR-15) was used to evaluate the quality of recovery at first and second day post-operation. Multiple regression analysis was used for analyzing the association of the type of general anesthesia with QoR-15.
Results: There was no significant difference of age, gender, body mass index (BMI), operation time, and the use of steroid between the two groups (all p > 0.05). Significant fewer patients had received antiemetics in total intravenous anesthesia group compared to those in inhalation anesthesia group (23.1% vs. 53.6%, p = 0.002). On the first day after surgery, the inhalation anesthesia group had the mean QoR-15 total score of 118.9 (standard deviation = 21.3), which was not significantly different from that in the total intravenous anesthesia group (118.5, standard deviation = 20.0, p = 0.921). There was no significant difference of the two-day postoperative QoR-15 total score between the two groups (p = 0. 960). Multivariate regression analysis showed that only BMI was significantly associated with one-day and two-day postoperative QoR-15 total score, and the type of general anesthesia was not.
Conclusion: This study revealed that the type of general anesthesia did not significantly affect the one-day and two-day postoperative quality of recovery in patients undertaking undergoing transaxillary endoscopic breast augmentation. All patients in this study had very good quality of recovery showed by high total scores of QoR-15, indicating that both type of general anesthesia were safe, effective techniques and provided qualified recovery in patients

中文摘要 I
Abstract III
目 錄 V
表目次 VII
圖目次 VIII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究重要性 4
第二章 文獻探討 5
第一節 隆乳手術的種類 5
第二節 不同全身麻醉方式的影響 6
第三節 影響手術後恢復品質的因素 15
第四節 手術後恢復品質的評估工具 26
第三章 研究方法 29
第一節 研究架構 29
第二節 研究變項及其操作型定義 30
第三節 研究假說 33
第四節 研究對象 34
第五節 研究工具 35
第六節 資料蒐集方法 37
第七節 資料處理與統計分析方法 38
第四章 研究結果 39
第一節 描述性分析結果 39
第二節 推論性分析結果 44
第三節 假說驗證結果 47
第五章 討論 48
第一節 全身麻醉方式對手術後恢復品質之影響 48
第二節 研究限制 53
第三節 未來研究建議 55
第四節 政策與管理意涵 56
第五節 結論 58
參考文獻 59
附 錄 73
附錄一、人體研究倫理委員會審查通過證明函 73
附錄二、Quality of Recovery-15問卷 74
附錄三、Stark et al.量表使用允許證明 76
附錄四、Bu et al.量表使用允許證明 77

表目次
表2-1、比較不同全身麻醉方式的相關文獻 6
表2 2、影響手術後恢復品質相關因素的文獻。 15
表2 3、十一種具有信效度的手術後恢復品質的評量工具 26
表2 4、三種手術後恢復品質的評量工具的比較 27
表3 1、研究變項之操作型定義與資料屬性 31
表3 2、經腋下內視鏡隆乳手術個案收案單 35
表4 1、比較吸入性麻醉組與完全靜脈麻醉組的病患個人屬性與手術相關因素 40
表4 2、比較手術後第一天吸入性麻醉組與完全靜脈麻醉組的QoR-15評估結果 42
表4 3、比較手術後第二天吸入性麻醉組與完全靜脈麻醉組的QoR-15評估結果 43
表4 4、複迴歸分析全身麻醉方式對手術後第一天恢復品質的影響 45
表4 5、複迴歸分析全身麻醉方式對手術後第二天恢復品質的影響 46

 
圖目次
圖3-1、研究架構圖 29

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