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系統識別號 U0007-1704200715033206
論文名稱(中文) 胸腔手術病人的術後疼痛、肺功能和肩功能之評估
論文名稱(英文) The Evaluation of Pain Response, Pulmonary and Shoulder Functions in Patients Receiving Thoracic Surgery
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 94
學期 2
出版年 95
研究生(中文) 洪儀珍
研究生(英文) I-Chen Hung
學號 M406091004
學位類別 碩士
語文別 中文
口試日期
論文頁數 90頁
口試委員 指導教授-賴裕和
指導教授-鄭綺
中文關鍵字 胸腔手術  術後疼痛  肺功能  肩功能 
英文關鍵字 thoracic surgery  postoperative pain  pulmonary function  shoulder function 
學科別分類
中文摘要 本研究是要探討胸腔手術病人術後的肺功能、肩功能和術後疼痛 的改變及兩者與疼痛的關係。研究採用前瞻性縱貫式研究設計,以方便取樣方式收案30位接受胸腔手術的病人,以0 - 10分數字型量表測量疼痛程度和記錄疼痛部位、性質、型態,以肺量計來測量肺功能的變化,以美國肩肘外科醫師會標準肩評估量表(American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES])來測量術後肩功能的變化,測量時間為術前一天、術後第一至七天、術後二週和術後六週。本研究之研究結果顯示病人術後六週內的肺功能、肩功能和術後疼痛有顯著的變化,用力吐氣肺活量和第一秒用力呼氣容積均在術後第一天降至最低,到術後六週可恢復為術前的86.8% (SD = 12.2)和87.7%(SD = 19.0)。以ASES肩功能分數指標測量肩功能,分數指標為0 - 100分,分數越高表示肩功能越好,在術後第一天平均肩功能分數指標降至最低,而後隨天數增加而回升,到術後六週可恢復為術前的94.2%(SD = 11.7)。術後疼痛部位主要在切割傷口上(49.3%),疼痛型態主要為身體活動時才痛(39.3%),疼痛的性質以抽痛(61.0%)為主,每日最痛疼痛強度的高峰發生在術後第二天,隨天數的增加而逐漸減緩為輕度疼痛,每日平均疼痛強度的高峰發生在術後第一天,術後六週內平均疼痛強度為輕度疼痛。術後一週內七天測量中,有四次的第一秒呼氣容積肺功能與平均疼痛強度呈現負相關(r = -.44至-.52),術後六週內6個測量時間點的肩功能分數指數中,有四次與平均疼痛強度呈現負相關(r = -.43至-.64),六次均與最痛疼痛強度呈現負相關(r = -.44至-.72)。胸管放置時間與術後六週內的用力吐氣肺活量呈現負相關(r = -.39至-.49),總傷口長度與術後六週內的肩功能分數指標呈現負相關(r = -.45至-.47),總傷口長度與術後六週內的最痛疼痛強度呈現正相關(r = -. 40至-.52)。接受胸腔鏡協助的胸腔手術的病人僅在術後第一天的最痛疼痛強度顯著低於胸廓切開術組病人的最痛疼痛強度。此研究結果可使護理人員瞭解病患在胸腔手術後生理功能與疼痛經驗的變化,肺功能和肩功能與疼痛的關係,可以在術後恢復期提供病患最適切的護理照護,增進病患對專業護理的滿意度。
英文摘要 The aim of this study were to evaluate the pain response, pulmonary and shoulder functions in patients receiving thoracic surgery, and the relationship between them. This study is a prospective longitudenal design and using convenient sampling 30 patients received thoracic surgery were collected. Each patient received preoperative day and postoperative days 1 - 7, and second, sixth weeks repeat testing. Postoperative pain were measured by 0 - 10 numeric rating scale and Pulmonary function were measured by spirometer and Shoulder function were measured by the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES). The findings of the study : there were significance change of pulmonary function, shoulder function and postoperative pain in the six weeks of postthoracic surgery. The forced vital capacity (FVC) and forced expiratory volume at one second (FEV1) were worse in the first day of post operation, and recovered to 86.8% (SD = 12.2) and 87.7% (SD = 19.0) of the preoperative baseline volume after six weeks. The shoulder function were worse in the first day of post operation, and recovered to 94.2% (SD = 11.7) of the preoperative baseline score after six weeks. The common pain experience was throbbing (61.0%) on incision wound, and the highest pain intensity occurred in postoperative day 2. There were significant correlation (r = -.44 to -.52) between FEV1 and average pain in 4 times of postoperative exam. There were significant correlation between shoulder score index and average pain (r = -.43 to -.64) in 4 times of postoperative exam and between shoulder score index and most pain (r = -.44 to -.72) in 6 times of postoperative exam. There were also significant correlation between the time of chest drains and FVC (r = -.39 to -.49) and between total incision length and shoulder score index (r = -.45 to -.47) and between total incision length and most pain (r = -.40 to -.52) in 6 weeks of postoperative period. The study result can help us to understand the relationship between physical function and pain experience after thoracic surgery for the clinical application.
論文目次 目 錄 頁數 致 謝 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ⅰ 中文摘要 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ⅱ 英文摘要 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ⅳ 目 錄 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ⅵ 圖表目次 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ⅸ 第一章 緒論 第一節 研究動機 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 第二節 研究目的 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 第二章 文獻查證 第一節 肺癌手術治療 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 第二節 術後疼痛 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 第三節 胸腔手術對肺功能的影響 . . . . . . . . . . . . . . . . . . . . . . . 11 第四節 胸腔手術對肩功能的影響 . . . . . . . . . . . . . . . . . . . . . . . 14 第五節 名詞界定 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 第六節 研究架構 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 第七節 研究假設 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 第三章 研究方法 第一節 研究設計 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 第二節 研究場所及對象 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 第三節 研究工具 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 第四節 研究變項及操作性定義 . . . . . . . . . . . . . . . . . . . . . . . . . 26 第五節 研究進行步驟 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 第六節 研究對象的權益保護 . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 第七節 資料分析 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 第四章 分析與結果 第一節 病患之人口學特性及手術相關資料 . . . . . . . . . . . . . . . 32 第二節 胸腔手術後的肺功能改變 . . . . . . . . . . . . . . . . . . . . . . . 38 第三節 胸腔手術後的肩功能改變 . . . . . . . . . . . . . . . . . . . . . . . 43 第四節 胸腔手術後的疼痛變化情形 . . . . . . . . . . . . . . . . . . . . . 48 第五節 術後疼痛與肺功能改變及肩功能改變的關係 . . . . . . . 56 第六節 胸腔手術對術後疼痛、肺功能及肩功能的影響 . . . . . 59 第五章 討論 第一節 胸腔手術後的肺功能改變 . . . . . . . . . . . . . . . . . . . . . . . 63 第二節 胸腔手術後的肩功能改變 . . . . . . . . . . . . . . . . . . . . . . . 67 第三節 胸腔手術後的疼痛變化情形 . . . . . . . . . . . . . . . . . . . . . 70 第六章 結論與建議 第一節 結論 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 第二節 護理上的運用與建議 . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 第三節 研究限制 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 參考資料 中文部分 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 英文部分 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 附錄 附錄一 研究同意書 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 附錄二 基本資料表 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 附錄三 疼痛評估量表 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 附錄四 肺功能表徵 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 附錄五 美國肩肘外科醫師會標準肩評估量表 . . . . . . . . . . . . . 92 圖表目次 圖一 胸腔手術病人之術後肩功能與肺功能變化的相關因素 . . 18 圖二 胸腔手術後肺功能的變化 . . . . . . . . . . . . . . . . . . . . . . . . . . 42 圖三 胸腔手術後的患側肩功能分數指標變化 . . . . . . . . . . . . 47 圖四 胸腔手術術後疼痛強度的變化 . . . . . . . . . . . . . . . . . . . . . . 52 表一 研究資料收集時間一覽表 . . . . . . . . . . . . . . . . . . . . . . . . . . 21 表二 統計分析一覽表 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 表三 胸腔手術病患基本資料 . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 表四 比較不同手術方式病人之術後鴉片類止痛藥用量 . . . . . . 36 表五 術後止痛藥使用情形 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 表六 比較不同手術方式病人術後的肺功能改變百分數 . . . . . . 40 表七 手術前後不同時間點的肺功能變化 . . . . . . . . . . . . . . . . . . 41 表八 比較不同手術方式病人術後的肩功能改變百分數 . . . . . . 45 表九 手術前後不同時間點的患側肩功能變化 . . . . . . . . . . . . . . 46 表十 胸腔手術術後疼痛部位、型態和性質的變化 . . . . . . . . . . 51 表十一 術後不同疼痛性質的強度變化 . . . . . . . . . . . . . . . . . . . . . . 52 表十二 比較不同手術方式病人的術後疼痛強度變化 . . . . . . . . . . 53 表十三 術後疼痛強度的變化 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 表十四 手術後不同時間點的肺功能與術後疼痛強度的相關 . . . . 57 表十五 手術後不同時間點的肩功能與術後疼痛強度的相關 . . . . 58 表十六 手術變項與術後疼痛強度、肺功能及肩功能的相關 . . . . 61 表十七 不同手術種類的平均疼痛強度、肺功能及肩功能差異 . . . 62
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