評估麻醉前衛教對全身麻醉脊椎手術患者之成效探討
衛教是護理人員的重要職責之一，亦被認為是具有成本效益的護理措施。然在手術麻醉前如能提供 病人相關的資訊及適當的護理指導，不但可降低病患對手術之焦慮，更可促進整個手術順利完成。
故本研究目的在於比較採全身麻醉之脊椎手術患者，經由病房護理人員或麻醉護士執行全身麻醉前 衛教之成效差異。本研究採兩組前後測設計法，樣本來源為中部某一家區域教學醫院之骨科住院病 人，以隨機分派方式，將研究對象分為實驗組與控制組，收案時間為 93 年 2 月至 93 年 4 月，共計 收案 65 人，實驗組 33 人，控制組 32 人，分別比較兩組之成本、焦慮程度、血壓、呼吸、心跳變 化情形、及滿意度之差異。研究資料以描述性統計及卡方檢定、 t 檢定、配對 t 檢定、皮爾森積差 相關等進行分析。
結果為： 1. 研究對象中，性別以男性佔多數，共 35 人；佔 53.8﹪ ，女性 30 人；佔 46.2﹪ ，教育 程度以國小程度者居多，共 20 人；佔 30.8﹪ ，手術次數以無經驗者佔多數，共 37 人； 56.9﹪ ， 以上變項均無顯著性差異 (p=.540;.542;.886) 。 2. 護理人員所花費的衛教人力時間成本，實驗組為 4 4.95 元，而控制組為 54.48 元；在降血壓藥物之成本方面，實驗組為 3.21 元；而控制組為 101.38 元
；在住院成本上，實驗組的平均住院日為 11.27 天（ 25,035.84 元），控制組為 12.19 天（ 27,011.1 4 元）；以上三項之總成本，實驗組為 25,084 元，而控制組為 27,167 元，且在兩組比較上並無顯 著性差異（ p=.173 ； p=.958 ）。 3. 在焦慮程度方面，兩組在衛教實施前後的得分平均差，實驗組 為 0.94 分，控制組為 0.16 分，結果顯示兩組具有顯著差異（ p=.006 ）。 4. 在收縮壓、舒張壓、心 跳及呼吸上亦均達顯著性差異（ p=.006 ； p=.002 ； p=.005 ； p=.009 ）。 5. 在滿意度方面，實驗 組的總分平均為 47.67 分（總分為 52 分），而控制組為 40.88 分，兩組在衛教實施後滿意度達顯著 差異（ p=.000 ）。
本研究結果顯示由麻醉護士實施全身麻醉衛教，不但可以節省衛教時間與藥物成本，亦可減輕手術 患者之焦慮程度，且提升病患滿意度，因此，在臨床上應大力推廣由麻醉護士執行手術前衛教指導
，以提升病患照護品質與減輕其焦慮程度。
關鍵詞：脊椎手術患者、麻醉前衛教、全身麻醉。
Evaluating the Effects of a pre-Anesthesia EducationProgram for Spinal Surgery Patients With General Anesthesia
Health education is one of an important task for nurses, and to be thought as a cost-effective intervention program. However, i f patients could obtain related information and receive appropriate nursing education before surgery, not only anxiety can be r educed, but also made operation completed. Therefore, the purpose of this study was to compare the effectiveness of a pre-ane sthesia education program for spinal surgery patients with general anesthesia by ward nurses or anesthesia nurses. The design was two groups pre-test and post-test comparison. Subjects were chosen from a region medical teaching hospital in middle of Taiwan and randomly assigned to experimental or control group, 33 for the experimental group and 32 for the control group.
Data were collected from February of 2004 to April of 2004. Costs, level of anxiety, blood pressure, respiration rate, and heart rate, patient satisfaction between two groups were compared. Data were analyzed using descriptive statistics, chi-square, t-test , paired t-test, and Pearson’s correlation.
The results were as follows: 1).For the demographic of the subjects, 35 were males (53.8%) ， 30 were females (46.2%). Twe nty subjects (30.8%) were elementary graduates. Patients with no previous surgery experience were the most (n= 37; 56.9%).
However, no significant differences were founbetween these two groups in three variables (p=.540; p=.542; p=.886, respectiv ely). 2). For the nurses’ labor costs, NT$ 44.95 was for the experimental group, NT$54.48 for the control group. For the hyper tensive medication costs, NT$ 3.21 was for the experimental group, NT$101.38 for the control group. For the hospitalization costs, 11.27 days (NT$25,035.84) were found for the experimental group, 12.19 days (NT$27,011.14) for the control group. T he total costs (labor costs + hypertensive medication costs+ hospitalization costs) were NT$25,084 for the experimental group and NT$27,167 for the control group. But, no significant difference was found between these two groups. 3). The average diff erent scores of the anxiety before and after education, 0.94 points for the experimental group and 0.16 points for the control gr oup and a significant difference was found (p=.000). 4). There was significant difference between these two groups in the cha nges of blood pressure, respiration rate, and heart rate. (p=.006; p=.002; p=.005; p=.009, respectively). 5. For the patient satisf action, the average scores were 47.67 points (total scores equal to 52 points) for the experimental group and 40.88 points for t he control group and a significant difference was found (p=.000).
The findings indicate that pre-surgery education should be performed by anesthetic nurses in order to decrease the labor and medication costs, to reduce patient’s anxiety, and to improve patient satisfaction. Hence, extending pre-surgery education by a nesthetic nurses is needed to improve the quality of patient care and to reduce patient’s anxiety.
