人工膝關節及髖關節置換術病患術後疼痛之分析

Analysis of Post-Operative Pain for Patients with Total Knee Replacement and Total Hip Replacement

10.29494/LN.201606_17(2).0008

吳依蘋(Yi-Ping Wu)；唐國民(Kwok-Man Tong)；洪麗珍(Li-Chen Hung)

全人工膝關節置換術 ； 全人工髖關節置換術 ； 術後疼痛 ； 疼痛影響 ； total knee joint replacement (TKR) ； total hip joint replacement (THR) ； postoperative pain ； pain effect

領導護理

17卷2期（2016 / 06 / 01）

80 - 93

繁體中文

預防術後疼痛是術後病人的權益，也是術後病患最重要且極為困擾的問題。本研究目的為探討人工膝、髖關節病患手術後疼痛及疼痛影響之差異。採縱貫式研究設計方式，以中部某醫學中心施行人工膝、髖關節置換術病患共150名，分為全人工膝關節置換術（TKR）極權人工髖關節置換術（THR）兩組。以結構式問卷、疼痛評估紀錄包括疼痛影響項目及視覺類比量表（VAS），收集術後三天疼痛評估資料並進行分析。研究結果發現術後疼痛程度及疼痛影響及發生率均隨時間增加而降低（P＜.001）；TKR組病患手術後疼痛程度高於THR組病患；然採MIS（微創）術式之病患疼痛程度雖於術後24小時略高於傳統術式，但術後48、72小時疼痛程度已明顯低於傳統術式，因此總結MIS（微創）術式之病患術後疼痛程度是較低的。兩組皆被不敢翻身的問題困擾，其次為失眠，TKR組在手術後24、48小時所產生的疼痛影響多於THR組，而THR組在術後72小時則多於TKR組。未來人工膝關節及髖關節置換手術後病患的疼痛程度，可藉由視覺類比量表得分的改變做為參考，並提供選擇合適的照顧措施協助。

Prevention of post-operative pain is a patient's right, but it has been an extremely distressing issue for post-operative patients. This study aims to investigate the post-operative pain variance between patients receiving total knee replacements and patients with total hip replacements. A longitudinal study design was used with a sample of 150 subjects at a medical center in central Taiwan. The subjects were divided into two groups: one group received total knee replacement (TKR) and the other group had total hip replacement (THR). Structured questionnaires, pain assessment records regarding adverse effects due to pain and visual analog scale (VAS) were utilized for data collection and analysis for three post-operative days. The results revealed that level of pain and occurrence of adverse effects due to pain decreased by time (p ＜ .001). The TKR group's pain level was higher than that of the THR group. Although the patients with minimally invasive surgery (MIS) had higher levels of pain compared with those who received traditional surgery during the post-operative 24 hours, the patients with MIS had significantly lower levels of pain 48 and 72 hours after surgery than the patients who had traditional surgery. In summary, patients with MIS had lower levels of pain. Both groups had problems with repositioning and insomnia was next. The TKR group suffered more adverse effects secondary to pain than the THR group did during 24 hours and 48 hours after surgery. The THR group suffered more pain than the TKR group did during the 72 hour post- operative period. We suggested that VAS can be used for patients' pain assessment after TKR and THR surgeries with the proper care measures provided.

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