策略性鎮靜治療措施在降低高齡胰十二指腸切除術患者之疼痛、焦慮與術後合併症之成效探討

Abstract

胰臟癌的患者多為老年人，而接受胰十二指腸切除術是其主要治療方式。高齡患者手術後有較高的致死率及合併症產生。鎮靜治療可以減除手術後病人的壓力反應，使其達到平靜緩和，以促進身體復原，因此本研究建立了一個策略性鎮靜措施在胰十二指腸切除術的年長患者身上，以探討其對手術預後的成效。本研究為實驗性設計，將56位接受胰十二指腸切除術且大於或等於65歲的病患隨機分為兩組，其中實驗組在手術後繼續使用呼吸器、轉入加護病房且接受Propofol靜脈注射為期5天，並維持其鎮靜程度在RASS躁動鎮靜量表的-2~-3分之間；控制組手術後即拔除氣管內管、恢復清醒並在一般病房接受手術後常規照護。觀察並記錄兩組病人的手術後合併症、疼痛與焦慮程度及手術後住院天數以作為本研究的結果指標。結果顯示在整體合併症中，實驗組的發生率為50%，控制組為75% (p=.053)，兩組無差異，但個別探討肺部合併症這一項，可發現實驗組的發生率是21.4%，控制組是53.6% (p=.047)，達統計上顯著意義。實驗組和控制組的手術後胃輕癱發生率分別是0%和6% (p=.031)，亦達統計上顯著差異；另外，實驗組亦比控制組呈現出顯著較輕手術後的疼痛與焦慮程度。實驗組與控制組的手術後住院天數則分別為49.9天與 51.4天(p=.657)，兩者無差異。經由研究結果得知，鎮靜治療措施可降低在胰十二指腸切除術年長患者手術後肺部合併症、胃輕癱發生率，並減緩疼痛及焦慮，但不增加其住院天數。

Sedation is the act of calming in critical nursing care and may relief the surgical stress syndrome. The patients receiving pancreaticoduodenectomy (PD) for pancreas cancer are usually old-aged and with high risk of postoperative morbidity. A randomized controlled trial is conducted to investigate whether strategic sedation is beneficial on postoperative recovery among geriatric patients. Fifty-six patients, who were older than 65 years and received PD, were randomly assigned into two groups, the sedation group and control group. The sedation group received postoperative sedation with Propofol injection and keep Richmond Agitation-Sedation Scale between -2 and -3 in the intensive care unit for five days, whereas the control group received early extubation postoperatively. The end-point of postoperative pain and anxiety level and complication rate was observed and recorded, as well as hospital length of stay (LOS). The result revealed that the overall complication rate was 50% in the sedation group and 75% in the control group, but not significantly different (p=.053). The pulmonary complication rate was significantly lower in the sedation group (21.4%) than in the control group (53.6%, 6 and 15 patients, respectively, p=.047). The postoperative gastroparesis was also significantly reduced in the sedation group (0%) as comparing with the control group (21.4%, 0 and 6 patients, respectively, p=.031). Postoperative pain and anxiety level were also decreased in the sedation group than in the control group (2.1 vs. 4.4, p=.020; 7.8 vs. 10, p=.020, respectively). The mean hospital LOS was not different between the sedation and control group (49.9 and 51.4 days, respectively, p=.657). By the study result, we suggest that sedation may be included as part of postoperative therapy to relieve the pain, anxiety and reduce postoperative pulmonary complication rate and gastroparesis without prolonging the hospital LOS on geriatric patients receiving PD.