[[alternative]]Explore The Pain Experiences And Related fators for Elderly Women During First time to Total Knee Replacement Surgery Period -A Longitudinal Study

[[abstract]]摘 要 本研究旨在探討40歲以上中老年婦女其首次接受膝關節置換手術後，於住院期間至返家後兩個月之疼痛經驗及其膝關節功能狀態之縱貫性研究。研究方法採縱貫性重複測量之研究設計，收案地點為北部某醫學中心，以立意取樣選取研究對象。分別於手術後至恢復室及住院期間四日收集研究對象的膝關節功能狀態與疼痛經驗，於手術後出院返家的第二週及第二個月收集研究對象的症狀困擾程度及疼痛經驗相關資料，研究工具包括VAS疼痛評估量表、台灣版標準化的疾病專一性功能表WOMAC及全膝關節置換手術病人術後常見症狀困擾量表，進行研究對象之資料收集，以SPSS 20.0進行描述性和推論性統計分析。 本研究結果：共50位40歲以上首次接受膝關節置換手術中老年婦女其平均年齡為68.7歲。在人口學變項與疼痛經驗之相關性，本研究結果顯示年齡小於65歲達統計上顯著差異(p<0.05)，在膝關節功能狀態與疼痛經驗部份，顯示負相關r=-.299(p<0.001)，在不同止痛方式部分與疼痛經驗方面，結果顯示研究對象手術後住院期間在不同的止痛方式中以膝關節以局部麻醉藥物浸潤合併每十二小時給藥的止痛方式達統計上顯著差異(p<0.05)，WOMAC功能分數呈現出在術後二週時膝關節疼痛程度及僵硬程度高於術前之情形，研究對象手術後第二週症狀困擾達統計上顯至差異的有：膝活動受限、疼痛、腫脹、瘀青、大腿麻、失眠及倦怠(p<0.005)。第二個月時的狀困擾達統計上顯至差異的有：膝活動受限、疼痛、容易生氣、憂鬱、失眠及倦怠(p<0.005)。 研究對象經手術返家後，除了要適應術後｢新的膝關節｣及肢體活動上等等不便，並且承受身體各種症狀程度的困擾，在對於首次接受膝關節置換手術的婦女經由本研究的實證資料顯示，進而能提供臨床醫護人員以及居家照護照護團隊，提供個案了解膝關節置換手術治療過程的身體變化進而提升照護品質。關鍵字：膝關節置換手術、疼痛經驗、止痛方式、症狀困擾[[abstract]]ABSTRACT Background: The pain experience and functional status of knee during total knee replacement surgery in older women returning home after hospitalization and surgery-related symptom distress factors.Objective: This longitudinal study aimed to explore women aged 40 and older whose pain experience and the functional status of the knee after total knee replacement surgery and their returning home after two-month study period from a medical center.Methods: The longitudinal repeated measurement method with purposive sampling was used in this study. Data were collected at four end-points: after surgery in the post-anesthesia care unit, four days after surgery, second week and second month. Research tools included VAS pain assessment scales, WOMAC function scale, and surgery-related symptom distress scale for total knee replacement surgery patients. The SPSS 20.0 software statistical package was used to analyze descriptive and inferential statistical data. Results: A total of 50 women over 40 years of age undergoing total knee replacement surgery participated in this study averaging 68.7 years of age. The result showed that patient’s age less than 65 years old had significant difference of pain experience(p <0.05). There were negative correlation between functional status and pain experience, r = - .299 (p <0.001). As far as for measuring anesthetic methods during hospitalization, combination of local anesthetic drug administration in every twelve hours had statistically significant in reducing patient’s pain (p <0.05). WOMAC functional score was higher after two weeks of surgery than before the surgery. The significant differences in surgery-related symptom distress after second week of surgery were knee limited mobility, pain, swelling, bruises, stiffness, insomnia, and fatigue (p <0.005). Surgery-related symptom distress after second month of surgery with significant differences were knee limited mobility, pain, easy to get angry, depressed, insomnia, and fatigue (p