中文摘要：
本研究目的在於暸解實施病患自控式止痛（patient controlled analgesia, PCA）與傳統術後肌肉注射止痛法（intramuscular analgesics, IM），在手術後止痛效果和成本的差異。傳統上手術後止痛方法，就是病患在手術後感覺到疼痛，接受肌肉注射止痛藥來減輕疼痛。PCA則是病患在手術後感覺到疼痛，透過自控式止痛器，自己控制止痛藥的劑量來達到減輕疼痛的目的。
本研究針對南部某一家區域醫院婦產科，接受婦科與產科開腹手術的病患共200位，其中PCA組124人，IM組76人，分別於手術後第一天、術後第二天，收集資料。利用手術後疼痛控制問卷表、疼痛程度數字等級量表、病歷審閱表、醫院成本資料，以病患、醫院的觀點，進行兩種模式的分析。
研究重要結果如下：一、PCA組個案比IM組在手術後止痛效果較好及手術後疼痛處置的滿意度較高，且均達到顯著性差異。二、兩組在止痛副作用方面，PCA組只有在皮膚癢顯著高於IM組（P< 0.01），其餘副作用兩組間無統計上差異。三、以醫院為觀點，PCA組平均每一位病患術後止痛成本為420.9±22.6元，IM組為228.4±60.1元，IM組較節省成本。
本研究結果顯示婦產科手術後病患，使用PCA可以提高止痛效果，提升病患對疼痛處理的滿意度，副作用方面只有皮膚癢的發生率顯著較高，但是成本較IM組高。
本研究對醫療服務業的建議：一、加強對醫護人員的術後止痛教育、主動評估病患術後疼痛控制；二、醫院可以加強術後疼痛控制的宣導，鼓勵病患善加利用PCA止痛；三、醫院可考慮採用不同的PCA儀器，來加強止痛效果與降低成本。四、持續PCA的研究與成本分析。

Abstracts:
The purpose of the study was to compare the efficacy and cost between intravenous patient-controlled analgesia (PCA) with intramuscular (IM) analgesics for women in the first two days after surgery.
The study included 200 patients who were assigned to receive PCA or intramuscular injections opioid during a period of 2 days after surgery. The PCA group included 124 patients and IM group had 76 patients. The data were collected using a structured questionnaires, patient chart review and hospital charge data.
The several findings were observed in this study. 1. The pain level in the PCA group was significantly lower than in the IM group (P< 0.01). The PCA group had significantly greater satisfaction with pain control than those in IM group (p< 0.01). The influence of activity by pain in the IM group had significantly greater than those in PCA group (p< 0.05). 2. The incidence of skin itching in PCA group was significantly higher than in the IM group （P< 0.01）.3. Cost per patient was higher for PCA group（NT$ 420.9±22.6）than IM group（NT$228.4±60.1）.
In conclusion, PCA produced better pain relief, get better patient’s satisfaction than conventional on-demand IM opioid injections but it was more expensive.

目 錄 頁次
第一章　緒論
第一節　研究動機…………………………………………………………………1
第二節 研究目的……………………………………………………………………2
第二章 文獻探討
第一節 手術後疼痛的控制…………………………………………………………3
第二節 病患自控式止痛的使用……………………………………………………9
第三節 手術後病患對疼痛控制滿意度的探討……………………………………13
第四節 手術後止痛成本分析………………………………………………………14
第三章 研究方法
第一節 研究架構與假設……………………………………………………………19
第二節 研究設計……………………………………………………………………20
第三節 研究變項……………………………………………………………………20
第四節 研究對象……………………………………………………………………22
第五節 研究評量工具測量…………………………………………………………22
第六節 研究步驟……………………………………………………………………25
第七節 資料分析……………………………………………………………………28
第四章 研究結果
第一節 研究對象之基本資料………………………………………………………29
第二節 止痛方式對疼痛程度與滿意程度之比較…………………………………30
第三節 止痛方式對術後疼痛造成影響之比較……………………………………31
第四節 止痛方式產生副作用之比較………………………………………………32
第五節 比較不同科別止痛方式造成疼痛程度、滿意程度及
手術後疼痛造成的影響…………………………………………………… 33
第六節 止痛方式對使用止痛藥及抗副作用藥物之比較…………………………35
第七節 止痛方式對術後止痛成本之比較…………………………………………36
第五章 討論
第一節 個人特性與疼痛控制的關係………………………………………………38
第二節 止痛方式與手術後疼痛程度的關係………………………………………39
第三節 手術後疼痛與疼痛處理滿意度的關係……………………………………40
第四節 手術後止痛藥的使用與產生副作用的關係………………………………41
第五節 止痛方式與手術後止痛成本的關係………………………………………42
第六章 結論與建議
第一節 結論…………………………………………………………………………44
第二節 建議…………………………………………………………………………45
第三節 研究限制……………………………………………………………………46

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