臺灣博碩士論文加值系統

背景：病患自控式止痛(patient controlled analgesia, PCA)通常是用於手術後提供急性期術後病患的疼痛控制，是一種可由病患自行操控的止痛方法。目前文獻多在比較不同途徑靜脈自控式止痛嗎啡或吩坦尼之滿意度差異，本研究以相同途徑來比較兩種藥物術後患者之滿意度。
目的：評估術後患者使用靜脈自控式止痛嗎啡及吩坦尼之滿意度，及了解其相關因素。
方法：本研究採回溯性資料分析，收案期間取自2018 年1 月至2019年6 月止，納入對象為使用靜脈自控式止痛(Intravenous Patient Controlled Analgesia, IVPCA)吩坦尼和嗎啡兩組。患者手術後兩天由疼痛部門進行詢問麻醉及自控式止痛整體滿意度，及評估手術後疼痛分數和副作用。麻醉整體滿意度是以單題來詢問患者。以羅吉斯迴歸分析IVPCA 感到非常滿意之相關因素，統計檢定之顯著水準訂為0.05。
結果：分別有237 位及249 位使用靜脈自控式止痛吩坦尼及嗎啡的患者。羅吉斯迴歸分析顯示，在加入疼痛指數及任一副作用後，男性對IVPCA 感到非常滿意的可能性高於女性(勝算比=1.72, 95%信賴區間=1.02-2.90, P=0.044)；體重較重者(1.02, 1.01-1.04, P=0.012)、手術部位為腹部手術者(1.88, 1.12-3.15, P=0.012)，對IVPCA 滿意的可能性較高。
結論：本研究比較使用二種止痛藥之滿意度，發現二者並無明顯差異；但止痛滿意度可能與性別、體重、手術部位有關。相關結果可提供醫師日後為患者選用藥物之考量，以提升患者使用靜脈自控式止痛之整體滿意度。

Backgrund: Patient controlled analgesia (PCA) is usually used to provide postoperative pain control for patients in the acute phase after surgery. It is a pain control method that can be controlled by patients themselves. At present, most of the literature is comparing the satisfaction of different routes of intravenous self-controlled analgesia morphine or fentanyl. This study uses the same approach to compare the satisfaction of patients after the two drugs.
Objective: To evaluate postoperative patients' satisfaction with the use of intravenous self-controlled analgesic morphine and fentanyl, and to understand the related factors.
Methods: Retrospective data analysis was used in this study. The period of collection was from January 2018 to June 2019. The subjects included were two groups: fentanyl and morphine using intravenous patient-controlled analgesia (Intravenous Patient Controlled Analgesia (IVPCA). Two days after the operation, the patient was asked by the pain department about the overall satisfaction of anesthesia and IVPCA, the postoperative pain score and side effects were evaluated. The overall satisfaction of anesthesia is to ask patients with a single question. According to the relevant factors that IVPCA was very satisfied with Logistic regression analysis, the statistical significance level was set at 0.05.
Results: There were 237 and 249 patients using intravenous self-controlled analgesic fentanyl and morphine, respectively. Logistic regression analysis shows that after adding the pain index and any side effects, men are more likely to be very satisfied with IVPCA than women (odds ratio=1.72, 95% confidence interval=1.02-2.90, P=0.044); body weight Heavier patients (1.02, 1.01-1.04, P=0.012) and those with abdominal surgery (1.88, 1.12-3.15, P=0.012) were more likely to be satisfied with IVPCA.
Conclusion: This study compared the satisfaction of using two analgesics, and found no significant difference between the two; however, analgesia satisfaction may be related to gender, weight, and surgical site. The relevant results can provide physicians with considerations for the selection of drugs for patients in the future, so as to improve the overall satisfaction of IVPCA confidence interval=1.02-2.90, P=0.044); body weight Heavier patients
(1.02, 1.01-1.04, P=0.012) and those with abdominal surgery (1.88, 1.12-3.15, P=0.012) were more likely to be satisfied with IVPCA.
Conclusion: This study compared the satisfaction of using two analgesics,and found no significant difference between the two; however, analgesia
satisfaction may be related to gender, weight, and surgical site. The relevant results can provide physicians with considerations for the selection
of drugs for patients in the future, so as to improve the overall satisfaction of IVPCA.

目錄
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 手術後疼痛的控制 3
第二節 病患自控式止痛(PCA)的概述 6
第三節 手術後病患對疼痛控制滿意度的探討 8
第四節 吩坦尼與嗎啡兩種藥物分析 11
第三章 研究方法 13
第一節 研究設計與對象 13
第二節 研究工具與信效度測量 15
第三節 資料整理與分析 17
第四節 研究流程 17
第五節 研究倫理考量 19
第四章 結果分析 20
第一節 研究對象之基本資料 20
第二節 使用不同止痛藥產生副作用和疼痛滿意度之比較 22
第三節 基本資料、臨床症狀與滿意度分數之雙變項分析 25
第四節 不同止痛藥整體滿意度之二元羅吉斯迴歸分析 29
第五章 討論 32
第一節 不同止痛藥對病患滿意程度之成效 32
第二節 使用兩種不同止痛藥之成效 35
第三節 以疼痛指標評估疼痛標準之成效 37
第四節 手術後止痛藥的使用與產生副作用的關係 39
第六章 結論與建議 41
參考文獻 42
附錄 48
附錄一研究倫理委員(IRB)同意臨床試驗證明書 48
表目錄
表1 病患基本資料分析 21
表2靜脈自控式止痛後疼痛指標、副作用和滿意度比較 24
表3滿意度與相關變項之雙變項分析 27
表4滿意度之疼痛分數及副作用有無羅吉斯迴歸分析 31
圖目錄
圖1：研究流程步驟 18

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