口腔顎顏面手術病患術後使用靜脈自控式止痛術的成效評估

Application of Patient-Controlled Analgesia (PCA) in Oral and Maxillofacial Surgical Patients

10.7104/TJOMS.200812.0260

黃振勳(Jehn-Shyun Huang)；王東堯(Tung-Yiu Wong)；張倍榮(Pei-Jung Chang)；蔡玉娟(Yu-Chuan Tsai)；陳畊仲(Ken-Chung Chen)

病患自控式止痛術 ； 口腔顎顏面手術 ； 疼痛緩解 ； 併發症 ； Patient-controlled analgesia ； morphine ； intravenous ； postoperative pain ； oral and maxillofacial surgery

臺灣口腔顎面外科學會雜誌

19卷4期（2008 / 12 / 01）

260 - 267

繁體中文

病患自拉式止痛術(Patient-Controlled Analgesia: PCA)是一種經由程式設計之裝置，給予病患自我調控的給藥模式，以使病患的手術後傷口疼痛得到緩解。本研究的目的爲評估麻醉止病藥經靜脈自控式止病裝置給藥，使用於口腔顎顏面外科手術病患的術後止痛成效及其副作用。研究方法係以87年6月到89年7月間，在本院口腔顎面外科住院接受全身麻醉手術的467位病患中，有40位病患同意接受術後使用靜脈自拉式止痛裝置治療，由麻醉醫師於手術後開立醫囑，並且每日由疼痛科專門護士追蹤詢問止痛效果與副作用發生情形。在這研究發現，病患對於使用街後靜脈自控式止痛裝置的治療效果感到滿意(100%)，能減輕病患術後的疼痛與不適(92.5%)，而且沒有嚴重的副作用如呼吸抑制或嚴重噁心、嘔吐等產生，值得在臨床上推廣。

Patient-controlled analgesia (PCA) is a technique of pain-control, in which the analgesia is administrated by a programmed device and could be adjusted by the patients themselves. The purpose of this study was to evaluate the efficiency of the patient-controlled analgesia applied in oral and maxillofacial surgical patients, and to explore the side effects and patients’ satisfaction. During Jun. 1998 till Jul. 2000, 40 Of 467 patients (8.75%) who had had major oral ad maxillofacial operations under general anesthesia, were enrolled in this study and received PCA postoperatively. Patients were visited daily postoperatively and the morphine requirement, side-effects, verbal rating scale of pain, and the satisfaction score were recorded during the pain management period. The average time of PCA use was 5.3 days. The most common side-effects encountered were dizziness or sleepiness, followed by nausea and vomiting, occurred in 27.5% frequency in the study group. The number of patients with adequate analgesia accounted for 92.5% (37/40) of the patients on the first day. The mean patient satisfaction rating was 1.55, which was denoted as satisfied. Most of the patients rated their opinion of the pain therapy with PCA as good and satisfied. Since there were no major complications related to the usage of PCA during the post-operative stag, it is worthwhile to appreciate the advantage of the PCA for the patients receiving oral and maxillofacial surgery.