臨床上病人常因抗拒脊髓麻醉導致手術治療被取消而延誤病情，或因此改用全身麻醉而增加呼吸道併發症的風險，故病人對於麻醉的看法在手術全期的臨床照護上是很重要的依據。因此，本研究目的在探討病人處於手術全期施行脊髓麻醉的經驗與感受。採用質性研究法，以立意取樣於中部某區域教學醫院，選擇手術施行脊髓麻醉的病人為收案對象，共收案10位，在手術後期之出院前一日，透過半結構式訪談指引進行深度訪談，依據質性內容分析法歸納主題。研究結果共呈現5個主題：「失去下半身知覺任人宰割」、「感受脊髓麻醉副作用」、「害怕手術過程意外及後遺症」、「麻醉護理師溫暖的陪伴」，以及「脊髓麻醉是種舒適的方法」。研究結果發現，麻醉護理師獨特的人性關懷與陪伴，對於手術病人具有深刻的影響。真心對待手術病人，提供有尊嚴且安全的護理，將使手術全期病人得以獲得良好的脊髓麻醉經驗。經過脊髓麻醉的病人是有正向的反應，共享醫療決策中傳達脊髓麻醉的舒適。祈藉由本研究結果能更深入瞭解手術病人對於脊髓麻醉的看法、感受及需求，並應用於臨床在手術前期病人脊髓麻醉的準備及麻醉評估，進一步作為麻醉護理師照護脊髓麻醉病人之參考，以提供更完整及適切的個別照護。

In clinical practice, patients often refuse spinal anesthesia, leading to surgical treatment cancellation and illness deterioration. Alternatively, patients may accept general anesthesia instead of spinal anesthesia, thereby increasing respiratory complication risk. What the patient thinks about anesthesia is crucial for clinical perioperative care. This study explored the experiences and perceptions of patients receiving spinal anesthesia during the perioperative period. Using a qualitative research method, purposive sampling was employed to recruit 10 patients who selected spinal anesthesia for their surgical treatment at a regional teaching hospital in Central Taiwan. On the day before their discharge, the patients were interviewed in depth in accordance with guidelines for semi-structured interviews, after which a qualitative analysis was performed to summarize the themes. The study findings presented five themes: “losing perception in the lower body and feeling vulnerable”, “feeling the side effects of spinal anesthesia”, “fear of accidents during the operation and their sequelae”, “kind companionship of the nurse anesthetist”, and “spinal anesthesia is comfortable”. The findings revealed that the unique humanitarian care and company of nurse anesthetists deeply influence surgical patients. Treating surgical patients sincerely and providing care with dignity and safety will allow patients in the perioperative period to have a favorable spinal anesthesia experience. Patients who had spinal anesthesia responded positively, and their comfort with spinal anesthesia can be conveyed and shared in medical decision-making. Hope the findings of this study can lead to further understanding of surgical patients’ opinions, feelings, and needs regarding spinal anesthesia. In addition, the findings can be applied to the preparation and evaluation of spinal anesthesia for patients in the initial stage of operations; they can serve as references for nurse anesthetists to care for spinal anesthesia patients and to provide them with more comprehensive and suitable individual care.

目 錄
摘要 I
Abstract II
目 錄 III
表目錄 V
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 名詞解釋 3
第二章 文獻探討 4
第一節 脊髓麻醉的相關介紹 4
第二節 脊髓麻醉病人的手術全期照護 5
第三節 脊髓麻醉對病人的影響 10
第三章 研究方法 12
第一節 研究設計 12
第二節 研究對象 12
第三節 研究工具 13
第四節 研究步驟 13
第五節 資料分析 14
第六節 研究嚴謹度 15
第七節 研究倫理 17
第四章 研究結果 18
第一節 研究對象的基本資料 18
第二節 手術全期病人的脊髓麻醉經驗 20
一、失去下半身知覺任人宰割 21
二、感受脊髓麻醉副作用 24
三、害怕手術過程意外及後遺症 26
四、麻醉護理師溫暖的陪伴 29
五、脊髓麻醉是種舒適的方法 32
第五章 討論 36
第一節 失去下半身知覺任人宰割 36
第二節 感受脊髓麻醉副作用 37
第三節 害怕手術過程意外及後遺症 38
第四節 麻醉護理師溫暖的陪伴 39
第五節 脊髓麻醉是種舒適的方法 41
第六章 結論與建議 43
第一節 結論 43
第二節 研究限制 43
第三節 研究建議與應用 44
第四節 研究歷程反思 46
參考文獻 47
中文部分 47
英文部分 50
附錄 56
附錄一 人體試驗委員會同意書 56
附錄二 半結構訪談指引 57

表目錄
表2-1 美國麻醉醫學會的身體狀態分類系統 6
表4-1 研究對象的基本資料 19
表4-2 手術全期病人的脊髓麻醉經驗之主題一覽表 20

中文部分
王采芷、郭裴翎(2019)‧進階護理的發展與現況‧源遠護理，13(1)，5-13。https://doi.org/10.6530/yyn.201903_13(1).0001
王瑞琪、黃暐琇、郭書麟(2019)‧術後加速康復療程(ERAS)不只是提早出院而已‧臺灣醫學，23(2)，184 -191。https://doi.org/10.6320/fjm.201903_23(2).0005
台灣麻醉護理學會（2018，4月14日）‧台灣麻醉護理學會理監事聯席會議紀錄摘要。https://www.tana.org.tw/newsflashword/第48期-4.4MB.pdf
台灣麻醉護理學會（2020，2月22日）‧台灣麻醉護理學會理監事聯席會議紀錄摘要。https://www.tana.org.tw/newsflashword/第52期-4.5MB.pdf
朱正一、曾稼志(2011)‧骨科手術病人之健康知能、知覺同理心、術前資訊理解程度與術前焦慮之探討‧醫務管理期刊，12(3)，177-190。https://doi.org/10.6174/jhm2011. 12(3).177
朱真一(2017)‧馬偕是台灣第一位麻醉師‧臺灣醫界，60(8)，47-50。
任秀如(2012)‧手術全期護理‧醫療品質雜誌，6(3)，27-30。
江晨恩、陸翔寧、劉宏恩(2014)‧赫爾辛基宣言2013年版‧臺灣醫界，57(4)，54-57。
吳淨寧(2009)‧手術室中的隱形天使--麻醉護理專業在台灣的建構與職場處境‧未發表碩士論文‧高雄：高學醫學大學性別研究所。
林小玲、王麗玲、謝雅宜、連金延、石宜銘、鄒樂起(2018)‧比較早期改變臥位與手術後平躺六小時其硬脊膜穿刺後頭痛的發生率～以採脊髓麻醉之腹股溝疝氣手術病人為例‧榮總護理，35(2)，112-125。https://doi.org/10.6142/vghn.201806_35(2).0001
林至芃、劉治民(2019)‧ERAS術中體溫維持‧臺灣醫學，23(2)，200-205。https://doi.org/10.6320/fjm.201903_23(2).0007
周珈汶、蘇輕感、陳秀翠(2009)‧區域麻醉後病人之護理‧源遠護理，3(1)，35-41。https://doi.org/10.6530/yyn.2009.3(1).05
施怡如(2007)‧全身麻醉在接受髖關節骨折復位手術的老老人是手術併發症的危險因子‧未發表碩士論文‧台中：中國醫藥大學醫學研究所。
施佳玟、羅惠敏(2011)‧手術中擺位傷害之護理‧護理雜誌，58(5)，101-106。https://doi.org/10.6224/jn.58.5.101
洪曉佩、曾麗華、雍允雯、林素萍、黃瓊慧、明金蓮(2019)‧術前焦慮概念分析‧榮總護理，36(2)，212-219。https://doi.org/10.6142/vghn.201906_36(2).0011
洪曉佩、楊淑玲、曾麗華、郭素真、吳祚光、趙瑩惠、明金蓮(2015)‧以質性研究探討接受全身麻醉病人之手術全期經驗‧高雄護理雜誌，31(1)，4-17 。https://doi.org/10.6692/kjn-2015-32-1-2
黃玉鈴、林慧玲、王方、吳淑芳(2015)‧預防手術後壓瘡照護流程之發展‧護理雜誌，62(6)，98-104。https://doi.org/10.6224/jn.62.6.98
國軍台中總醫院（2018，3月9日）‧脊髓麻醉。https://803.mnd.gov.tw/ws-upload/2018/01/0309_data3.pdf
梁淑媛、莊宇慧、吳淑芳(2012)‧內容分析技巧在護理質性資料之初步應用‧護理雜誌，59(5)，84-90。https://doi.org/10.6224/jn.59.5.84
陳姿言(2017)‧探討不同麻醉方式對剖腹產術後表現之產婦及新生兒影響—以中部某醫學中心為例‧未發表碩士論文‧台中：中臺科技大學醫療暨健康產業管理研究所。
陳美菊、龔秀華、湯玉珊、簡麗瑜(2016)‧改善骨科手術前病人焦慮程度之專案‧長庚護理，27(2)，197-208。https://doi.org/10.3966/1026730120
梅滙潮(2011)‧手術前後麻醉照顧病人滿意度問卷之發展‧未發表碩士論文‧嘉義：國立中正大學企業管理研究所。
賈如瓊、鄭淑英、張璇其、吳貞慧、黃瓊慧、張杏芬、楊淑玲、洪曉佩(2016)‧探討術前多媒體護理指導於腰椎麻醉病人焦慮之成效‧榮總護理，33(4)，332-343。https://doi.org/10.6142/vghn.33.4.332。
衛生福利部統計處（2020，2月14日）‧107年度醫療服務量。https://dep.mohw.gov.tw/DOS/cp-4487-48525-113.html
衛生福利部台中醫院（2019，3月26日）‧全身麻醉好還是半身麻醉好。https://www.taic.mohw.gov.tw/?aid=509&pid=84&page_name=detail&type=968&iid=1908
衛生福利部豐原醫院（2016，6月1日）‧台灣病人最排斥的麻醉方式：半身麻醉。https://www.fyh.mohw.gov.tw/?aid=509&pid=0&page_name=detail&iid=903
劉向援(2016)‧手術全期護理之原則‧於劉雪娥總校閱，成人內外科護理（七版，251-366頁）‧華杏。
劉志中、孫孝倫、李怡慧、簡志誠、何善台(2011)‧半身麻醉不會增加術後下背痛的風險‧疼痛雜誌，21(2)，35-40。https://doi.org/10.29792/ttjp.201109.0001
鄭偉君、謝明蓁、李崗(2019)‧麻醉護理師專業訓練之課程設計與實施‧醫學與健康期刊，8(1)，85-96。
潘淑滿(2003) ‧質性研究理論與應用（初版）‧心理。
謝美惠、王秀紅(2011)‧護病互為主題的陪伴概念與意涵‧志為護理-慈濟護理雜誌，10(4)，56-63。https://doi.org/10.6974/TCNJ.201108.0056
謝恩得（2014，9月23日）‧醫生研究：台灣人莫名恐懼麻醉‧聯合新聞網。https://health.udn.com/health/story/6012/354946
薛淑文、陳惠敏、李佳容(2015)‧音樂治療對接受泌尿外科手術患者其焦慮及壓力改善之成效‧高雄護理雜誌，32(3)，6-18。https://doi.org/10.6692/kjn-2015-32-3-2
Miller, R. D., & Pardo, M. C. (2014)‧Miller大師引領您讀通麻醉學：麻醉學的基礎讀本（張家穎、洪明輝、藍正妍、王婷鈺、許銘哲、林宜樺、吳長庭、王顥瑾編譯；初版）‧合記。（原著出版於2011）
Morgan, G. E., & Mikhail, J. M. (2003)‧臨床麻醉學（林品村總編譯；初版）‧合記。（原著出版於1996）
Rothrock, J. C. (2014)‧手術全期護理實務基礎（伍宴鈴、何文佑、何嘉倫、李育茹、李則平、李瓊淑編譯；14版）‧愛思唯爾。（原著出版於2011）
英文部分
Alanazi, A.A. (2014). Reducing anxiety in preoperative patients: a systematic review. British Journal of Nursing, 27 (3), 387-393. https://doi.org/10.10968/bjon. 2014.23.7.387
Bager, L., Konradsen, H., & Dreyer, P. S. (2015). The patient's experience of temporary paralysis from spinal anaesthesia, a part of total knee replacement. Journal of Clinical Nursing, 24, 3503-3510. https://doi.org/10.1111/jocn.13007
Bheemanna, N. K., Channaiah, S. R. D., Gowda, P. K. V., Shanmugham, V. H., & Chanappa, N. M. (2017). Fears and perceptions associated with regional anesthesia: a study from a tertiary care hospital in south India. Anesthesia Essays Research, 11(2), 483-488. https://doi.org/10.4103/aer.AER_51_17
Blüml, V., Stammler-Safar, M., Reitinger, A. K., Resch, I., Naderer, A., & Leithner, K. (2012). A qualitative approach to examine women's experience of planned cesarean. Jouranl Obstetric, Gynecologic, and Neonatal Nursing, 41(6), 82-90. https://doi.org/10.1111/j.1552-6909.2012.01398.x
Bradt, J., Dileo, C., & Shim, M. (2013). Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews, (6), Cd006908. https://doi.org/10.1002/14651858.CD006908.pub2
Celik, F., & Edipoglu, I. S. (2018). Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. European Journal of Medical Research, 23(1), 41. https://doi.org/10.1186/s40001-018-0339-4
Chan, Y. L., Wong, K. L., Lin, C. F., Rau, R. H., Wu, K. H., & Wei, T. T. (1998). Views of obstetric patients who refuse regional anesthesia in cesarean section. Acta Anaesthesiologica Sinica, 36(2), 99-102.
El Boghdady, M., & Ewalds-Kvist, B. M. (2020). The influence of music on the surgical task performance: A systematic review. International Journal of Surgery, 73, 101-112. https://doi.org/10.1016/j.ijsu.2019.11.012
Henningsen, M. J., Sort, R., Moller, A. M., & Herling, S. F. (2018). Peripheral nerve block in ankle fracture surgery: a qualitative study of patients' experiences. Anaesthesia, 73(1), 49-58. https://doi.org/10.1111/anae.14088
Ilkkaya, N.K., Ustun, F. E., Sener, E. B., Kaya, C., Ustun, Y. B., Koksal, E., Kocamanoglu, I. S., & Ozkan, F. (2014). The effects of music, white noise, and ambient noise on sedation and anxiety in patients under spinal anesthesia during surgery. Journal of PeriAnesthesia Nursing, 29(5), 418-426. https://doi.org/10.1016/j.jopan.2014.05.008
Jlala, H. A., Bedforth, N. M., & Hardman, J. G. (2010). Anesthesiologists' perception of patients' anxiety under regional anesthesia. Local and Regional Anesthesia, 3, 65-71. https://doi.org/10.2147/lra.s11271
Karlsson, A. C., Ekebergh, M., Mauleon, A. L., & Osterberg, A. S. (2012). "Is that my leg?" patients' experiences of being awake during regional anesthesia and surgery. Journal of PeriAnesthesia Nursing, 27(3), 155-164. https://doi.org/10.1016/j.jopan.2012.02.005
Kömürcü, E., Kiraz, H. A., Kaymaz, B., Gölge, U. H., Nusran, G., Göksel, F., Şahin, H., Ömür, D., & Hancı, V. (2015). The effect of intraoperative sounds of saw and hammer on psychological condition in patients with total knee arthroplasty: Prospective randomized study. Scientific World Journal, 2015, 690569. https://doi.org/10.1155/2015/690569
Korstjens, I., & Moser, A. (2018). Series: practical guidance to qualitative research. Part 4: trustworthiness and publishing. European Journal of General Practice, 24(1), 120-124. https://doi.org/10.1080/13814788.2017.1375092
Lee, J. S., Park, Y. M., Ha, K. Y., Cho, S. W., Bak, G. H., & Kim, K. W. (2016). Preoperative anxiety about spinal surgery under general anesthesia. European Spine Journal, 25(3), 698-707. https://doi.org/10.1007/s00586-015-3788-2
Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Sage.
Luggya, T. S., Kabuye, R. N., Mijumbi, C., Tindimwebwa, J. B., & Kintu, A. (2016). Prevalence, associated factors and treatment of post spinal shivering in a sub-saharan tertiary hospital: a prospective observational study. BMC Anesthesiology, 16(1), 100. https://doi.org/10.1186/s12871-016-0268-0
Miller, R. D. (2015). Miller’s anesthesia (8th ed). Elsevier.
Mitchell, M. (2013). Anaesthesia type, gender and anxiety. Journal Perioperative Practice, 23(3), 41-47. https://doi.org/10.1177/175045891302300301
Moser, A., & Korstjens, I. (2018). Series: Practical guidance to qualitative research. Part 3: sampling, data collection and analysis. European Journal of General Practice, 24(1), 9-18. https://doi.org/10.1080/13814788.2017.1375091
Mulugeta, H., Ayana, M., Sintayehu, M., Dessie, G., & Zewdu, T. (2018). Preoperative anxiety and associated factors among adult surgical patients in Debre Markos and Felege Hiwot referral hospitals, Northwest Ethiopia. BMC Anesthesiology, 18(1), 155-163. https://doi.org/10.1186/s12871-018-0619-0
Onishi, E., Murakami, M., Hashimoto, K., & Kaneko, M. (2017). Optimal intrathecal hyperbaric bupivacaine dose with opioids for cesarean delivery: a prospective double-blinded randomized trial. International Journal of Obstetric Anesthesia, 31, 68-73. https://doi.org/10.1016/j.ijoa.2017.04.001
Park, S., Kim, K., Park, M., Lee, U., Sim, H.S., Shin, I.S., & Song, Y. (2018). Effect of 24-hour bed rest versus early ambulation on headache after spinal anesthesia: systematic review and meta-analysis. Pain Management Nursing, 19(3), 267-276. https://doi.org/10.1016/ j.pmn.2017.10.012
Pereira, C., Sobreira, F. D., Carmezim, M. A., Gonçalves, G., Pinho, S., Araújo, M., Pereira, F., Saraiva, A., Paiva, M., Nunes, C. S., Cavaleiro, C., & Machado, H. (2018). Anaesthesia related fears a cross sectional survey among the Portuguese population. International Journal of Anesthesiology & Research , 6(1), 494-499. https://doi.org/10.19070/2332-2780-18000100
Perlas, A., Chaparro, L. E., & Chin, K. J. (2016). Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and meta-analysis. Regional Anesthesia and Pain Medicine, 41(2), 251-260. https://doi.org/10.1097/aap.0000000000000184
Pirbudak, L., Ozcan, H. I., & Tumturk, P. (2019). Postdural puncture headache: Incidence and predisposing factors in a university hospital. Journal of the Turkish Society of Algology, 31(1), 1-8. https://doi.org/10.5505/agri.2018.43925
Pu, X., & Sun, J. M. (2019). General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty: a meta-analysis. Medicine (Baltimore), 98(16), e14925. https://doi.org/10.1097/md.0000000000014925
Pulkkinen, M., Junttila, K., & Lindwall, L. (2016). The perioperative dialogue - a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia. Scandinavian Journal of Caring Sciences, 30(1), 145-153. https://doi.org/10.1111/scs.12233
Qiu, C., Chan, P. H., Zohman, G. L., Prentice, H. A., Hunt, J. J., LaPlace, D. C., Nguyen, V. T., Diekmann, G. R., Maletis, G. B., & Desai, V. (2018). Impact of anesthesia on hospital mortality and morbidities in geriatric patients following emergency hip fracture surgery. Journal of Orthopaedic Trauma, 32(3), 116-123. https://doi.org/10.1097/BOT.0000000000001035
Rastipisheh, P., Choobineh, A., Razeghi, M., Kazemi, R., Ghaem, H., Taheri, S., & Maghsoudi, A. (2019). The effects of playing music during surgery on the performance of the surgical team: A systematic review. Work, 64(2), 407-412. https://doi.org/10.3233/wor-192984
Rhee, W. J., Chung, C. J., Lim, Y. H., Lee, K. H., & Lee, S. C. (2010). Factors in patient dissatisfaction and refusal regarding spinal anesthesia. Korean Journal of Anesthesiology, 59(4), 260-264. https://doi.org/10.4097/kjae.2010.59.4.260
Salam, A. A., & Afshan, G. (2016). Patient refusal for regional anesthesia in elderly orthopedic population: a cross-sectional survey at a tertiary care hospital. Journal of Anaesthesiol Clinical Pharmacology, 32(1), 94-98. https://doi.org/10.4103/0970-9185.173372
Saygi, A. I., Ozdamar, O., Gun, I., Emirkadi, H., Mungen, E., & Akpak, Y. K. (2015). Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial. Sao Paulo Medical Journal, 133(3), 227-234. https://doi.org/10.1590/1516-3180.2014.8901012
Smeltzer, S. C., Wint, A. J., Ecker, J. L., & Iezzoni, L. I. (2017). Labor, delivery, and anesthesia experiences of women with physical disability. Birth, 44(4), 315-324. https://doi.org/10.1111/birt.12296
Sundqvist, A. S., & Carlsson, A. A. (2014). Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy. Scandinavian Journal of Caring Sciences, 30(2), 281-288. https://doi.org/10.1111/scs.12057
Sundqvist, A. S., Nilsson, U., Holmefur, M., & Anderzen-Carlsson, A. (2018). Promoting person-centred care in the perioperative setting through patient advocacy: an observational study. Journal of Clinival Nursing, 27(11-12), 2403-2415. https://doi.org/10.1111/jocn.14181
Tanaka, M., Takahashi, T., & Yamamoto, H. (2003). Simultaneous live video presentation during knee arthroscopy. Journal of Orthopaedic Science, 8(4), 518–521. https://doi.org/10.1007/s00776-003-0670-6
Weldon, S. M., Korkiakangas, T., Bezemer, J., & Kneebone, R. (2015). Music and communication in the operating theatre. Journal of Advanced Nursing, 71(12), 2763-2774. https://doi.org/10.1111/jan.12744
Yilmaz, E., Toğaç, H. K., Çetinkaya, A., & Toğaç, S. (2020). A qualitative study of the operating room experience of patients who underwent surgery under spinal anesthesia: "It was like an adventure". Nursing & Health Sciences, (Epublish ahead of print) https://doi.org/10.1111/nhs.12708
Ying, L. C., Levy, V., Shan, C. O., Hung, T. W., & Wah, W. K. (2001). A qualitative study of the perceptions of Hong Kong Chinese women during caesarean section under regional anaesthesia. Midwifery, 17(2), 115-122. https://doi.org/10.1054/midw.2000.0249.
Zhang, Y., & Wong, K. C. (1999). Anesthesia and postoperative shivering: Its etiology, treatment and prevention. Acta Anaesthesiologica Sinica, 37(3), 115-120. https://doi.org/10.6955/aas.199909.0115