臺灣博碩士論文加值系統

惡性腫瘤(也就是俗稱癌症) 巳連續多年位居國內十大死因第一位，以癌症發生人數而言，96年發生人數最高的癌症為大腸直腸癌，總共有10,511人罹患大腸直腸癌，如何早期發現和治療大腸直腸癌，已成為國內醫界和公衛學界的一個重要課題。在目前較常使用的檢查工具中，大腸鏡是公認診斷大腸直腸癌最好的工具，在大腸鏡檢查的同時也可以進行治療，這是其他檢查無法做到的。但是在進行大腸鏡檢查時，患者往往會覺得腹部脹痛和不適，這也是一般民眾恐懼大腸鏡檢查的最大原因之一。
為了提昇大腸鏡檢查的醫療服務品質和滿意度，降低民眾對大腸鏡檢查的恐懼，近年來開始推廣在麻醉下為病患進行大腸鏡檢查，也就是俗稱的“無痛大腸鏡”，本研究主要是探討不同麻醉方式(全身靜脈麻醉、靜脈鎮靜劑注射和無射任何藥物)進行大腸鏡檢查，病患的滿意度的差異，期望藉由此研究找出滿意度最高的一種麻醉方式，提升大腸鏡的醫療品質，醫院管理者並可以研究結果擬定大腸鏡的行銷策略，達到增加醫院營收的最終目標。
本研究是以苗栗縣某地區教學醫院大腸直腸外科檢查室為收案場所，研究採用問卷方式進行，病患滿意度主要分3個構面來分析：包括檢查的疼痛度、檢查後腹部脹痛程度及檢查後是否覺得頭暈和噁心，在病患檢查甦醒後後，由研究者以固定相同的詞句進行問卷調查，以結構式問卷訪談進行資料收集，進一步再分析研究。
本次研究共發出 200 份問卷，回收 200 份問卷，剔除填答不完全的問卷後，共189份有效問卷進行統計分析。研究結果顯示在檢查的疼痛度方面，全身靜脈麻醉讓個案對大腸鏡檢查後的疼痛認知最輕微，其次為靜脈鎮靜劑注射，疼痛感覺最強烈為無任何藥物之檢查方式，其中女性、大腸息肉並切除息肉的患者檢查疼痛度程度顯著高其他患者，在檢查後腹部脹痛程度方面，全身靜脈麻醉下進行大腸鏡檢查，病患檢查後比較不會有脹痛的感覺，另外女性患者對檢查後脹痛的感覺顯著高於男性，在檢查後頭暈和噁心程度方面，注射靜脈鎮靜劑對大腸鏡檢查後的頭暈、噁心認知平均數都顯著高於全身靜脈麻醉方式與無任何藥物分組的個案。
本研究綜合以上分析並歸結下列結論與建議：全身靜脈麻醉下接受大腸鏡檢查的患者，檢查後疼痛、腹脹和頭暈噁心的認知平均數都顯著低於其他兩種麻醉方式，可說是滿意度最高的一種麻醉方式，為了提昇大腸鏡的醫療服務品質，應考慮使用全身靜脈麻醉為患者檢查，讓病患對檢查覺得滿意。女性患者、大腸息肉並切除息肉和檢查時間較長的病患在疼痛和腹脹的認知程度明顯高於其他病患，為了減輕檢查時的不適，應優先考慮使用全身靜脈麻醉。醫院應推廣在全身靜脈麻醉下為病患進行大腸鏡檢查，以在提昇大腸鏡的醫療服務品質的目的，為了讓病患有選擇的權利，醫院應同時跟病患解釋各種麻醉方式的優缺點，讓病患自行決定選擇使用那一種麻醉方式接受檢查。

Cancer is the number one cause of death in Taiwan for many years. In 2007, colorectal cancer has taken the first place in incidence of cancer and 10,511 people have suffered from colorectal cancer. Early detection and early treatment of colorectal cancer have already become an important issue in medical and public health society. Among the different diagnostic tools of colorectal cancer, colonoscopy is the gold standard procedure for detecting and confirming colon cancer. During colonoscopy, patients often feel abdominal pain with discomfort and this is the most important reason why people fear about colonoscopy.
In order to improve the medical quality and patient satisfaction of colonoscopy, many hospitals begin to promote anesthesia for colonoscopy, also known as "painless colonoscopy ". The aim of this study is to investigate patient’s satisfaction difference among different anesthesia for colonoscopy (Intravenous general anesthesia, intravenous sedation and no injection). We hope by this study we can identify a highest approach to perform colonoscopy and improve the quality of colonoscopy. Base on the result of this study, hospital management can develop marketing strategy for colonoscopy, reaching the ultimate goal of increasing hospital revenue.
Patients receiving colonoscopy at a regional teaching hospital colonoscopy center in Miaoli County were recruited in this study. This study used a questionnaire-based survey. Patient satisfaction was divided into three dimensions for analysis: degree of pain during examination, degree of abdominal distention after examination, degree of dizziness, vomiting after examination. When patient awoke from examination, a structured questionnaire was submitted to patients. Data was collected for further analysis.
A total of 200 questionnaires had been distributed and retrieved. After removing 12 incomplete questionnaires, 189 valid questionnaires were collected for data analysis. Results of this study revealed that patients receiving intravenous general anesthesia had the slightest pain cognition, followed by intravenous sedation. Patients without any sedation had the strongest pain cognition. Female, patients with colonic polyp required polypectomy had remarkable higher degree of examination pain than other patients. Patients receiving intravenous general anesthesia were less likely to have abdominal distention. Female patients felt significant abdominal distention than male patients. Patients receiving intravenous sedation had significant higher degree of dizziness and vomiting than other group of patients.
The result of the analysis revealed that for patients receiving intravenous general anesthesia for colonoscopy, the degree of examination pain, post-examination abdominal distention, dizziness and vomiting was significantly lower than others. Intravenous general anesthesia has the highest patient satisfaction for patient receiving colonoscopy. In order to improve the medical quality of colonoscopy, intravenous general anesthesia should be widely accepted. Female, patients with colonic polyp required polypectomy and patients with longer examination time should consider intravenous general anesthesia to relief their examination discomfort. Hospital management should prompt intravenous general anesthesia for colonoscopy in order to improve the quality of colonoscopy.

書名頁…………………………………………………… I
論文 …………………………………………………… II
授權書 ………………………………………………… III
中文提要 ……………………………………………… IV
英文提要 ……………………………………………… VI
誌謝 ……………………………………………………… VIII
目錄 …………………………………………………… IX
表目錄 ………………………………………………… XI
圖目錄 …………………………………………………… XIII
第一章 緒論 ……………………………………… 1
1.1 研究動機 ………………………………………… 1
1.2 研究目的 ……………………………………… 4
1.3 研究流程 ……………………………………… 5
第二章 文獻探討 ………………………………… 6
2.1.1醫療品質和病患滿意度 ……………………… 6
2.1.2大腸直腸癌現況、成因和治療 ……………… 6
2.1.3大腸直腸癌的診斷工具 ……………………… 8
2.1.4 麻醉在大腸鏡檢查的應用 …………………… 10
2.2研究假說與架構 ………………………………… 12
2.2.1研究假說 ……………………………………… 12
2.2.2研究架構 ……………………………………… 12
2.2.3研究方法 ……………………………………… 13
2.2.4研究工具……………………………………… 14
第三節 研究結果分析 ………………………………… 16
3.1.1樣本人口統計變數及檢查資料分析…………… 16
3.1.2 個案檢查、麻醉與疼痛相關認知分析……… 17
3.2 大腸鏡檢查後病患疼痛程度分析……………… 19
3.3 大腸鏡檢查後病患脹痛程度分析……………… 31
3.4 大腸鏡檢查後病患頭暈、噁心程度分析 ……… 35
第四節結論與建議 ………………………………… 42
4.1結論與討論 ……………………………………… 42
4.2研究限制 ………………………………………… 47
4.3研究建議 ………………………………………… 47
4.3.1給病患的建議 ………………………………… 47
4.3.2給醫院的建議 ………………………………… 58
參考文獻 …………………………………………… 49
附錄一：問卷調查表 ………………………………… 55

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