當人口高齡化與日增的神經系統退化問題，許多國內外研究指出，脊椎手術若採用傳統開刀方式，伴隨著手術及麻醉的高風險，常讓病患術後通常需要較長的恢復期、疼痛管理、住院天數和復健安排。本研究評估開放式脊椎手術全身麻醉中，運用術後加速康復療程的最適肌張力手術輔助處置，評估使用不同肌肉鬆弛劑和拮抗劑藥物組合對醫療照護品質和效益影響。
在南部一間醫學中心進行回溯觀察性世代研究，共有402名成人患者接受五類脊椎手術，分別為脊椎融合術、減壓術、椎間盤切除術、脊髓腫瘤切除術及其他手術，當中患者經由1:1傾向評分配對分為cisatracurium和neostigmine與rocuronium和最適肌張力手術輔助處置兩組，剖析各組基本資料、各項手術期間和術後臨床變數因子；另外也進行單變量和多變量邏輯迴歸分析，討論導致住院天數延長的相關獨立風險因子。
研究結果顯示使用rocuronium和最適肌張力手術輔助處置與縮短住院時間之間存在顯著相關性，且病患術後追蹤肺部X光影像異常報告有較低的發生率；住院天數超過7天之多變量邏輯迴歸分析中，rocuronium和最適肌張力手術輔助處置雖然未對住院天數的延長具有顯著的影響，但在麻醉深度導向的麻醉監測、美國麻醉醫師學會生理狀態III級、術中輸液量及失血量較多、和術後追蹤肺部X光異常等變數比較，發現對延長住院天數有顯著影響。文獻回顧醫療品質與效益成效表現，儘管最適肌張力手術輔助處置的成本費用較高，但術後併發症的降低和恢復時間的加快有助於降低整體住院成本。面對眾多醫療照護準則與建議，希望更多醫療團隊投入大型前瞻性臨床研究，善用醫療資源分配及全方位醫療照顧，有助於臨床藥物或處置來選擇參考，將來讓醫護人員與民眾面對醫療風險時能創造更佳保護力。

As the population ages and neurological degeneration issues increase day by day, research from various countries has indicated that traditional open spine surgery carries high risks associated with surgery and anesthesia, often requiring patients to have a longer recovery period, pain management, extended length of stay (LOS) and rehabilitation arrangements. This study evaluates the use of optimal muscle tension (OMT) in the enhanced recovery after surgery (ERAS) during general anesthesia for open spine surgery, assessing the impact of different combinations of muscle relaxants and antagonist drugs on the quality and efficiency of medical care.
A retrospective cohort study was conducted at a medical center in southern Taiwan, involving 402 adult patients who underwent five types of spinal surgeries： spinal fusion, decompression, discectomy, spinal tumor removal, and other surgeries. Patients were divided into two groups through 1：1 propensity score matching: one group receiving cisatracurium and neostigmine and the other giving rocuronium and OMT. The study analyzed baseline data, perioperative clinical variables, and postoperative clinical factors for each group; it also performed univariate and multivariate logistic regression analyses to discuss independent risk factors contributing to extended LOS.
The results showed a significant correlation between the use of rocuronium with OMT and shorter hospital stays, with a lower incidence of abnormal findings in postoperative chest X-ray examinations. However, the multivariate logistic regression analysis of hospital stays longer than seven days did not find a significant effect of rocuronium and OMT on the extension of hospital days. Instead, variables such as anesthesia depth-oriented monitoring, American Society of Anesthesiologists (ASA) physical status III, higher intraoperative fluid and blood loss, and abnormal postoperative chest X-ray reports were found to impact the LOS significantly. Despite the higher cost of the OMT, the reduction in postoperative complications and faster recovery times contribute to lowering overall hospital costs. Faced with numerous medical care standards and recommendations, it is hoped that more medical teams will engage in large-scale prospective clinical research, making good use of medical resource allocation and comprehensive medical care to help choose clinical drugs or treatments, ultimately providing better protection for medical staff and the public when facing medical risks in the future.

論文審定書……………………………………………………………………….…i
誌謝…………………………………………………………………………………ii
摘要…………………………………………………………………………………iii
Abstract ………..………………………………………………………………..…iv
目錄…………………………………………………………………………………vi
圖次……………………………………………………………………………...…vii
表次……………………………………………………………………………..…viii
第一章 緒論………………………………………………………………………01
第一節 研究背景與動機……………………………………………………05
第二節 研究目的……………………………………………………………05
第二章 脊椎手術與全身麻醉現況 …………………….……………………….06
第一節 脊椎手術 ……..……………………………………………………06
第二節 全身麻醉 …………………………………………..………………08
第三節 術後加速康復療程 ………………………………………..………10
第三章 研究設計…………………………………………………………………12
第一節 研究流程結構………………………………………………………12
第二節 研究統計分析………………………………………………………14
第三節 研究範圍與限制……………………………………………………15
第四節 研究過程……………………………………………………………18
第五節 研究數據分析………………………………………………………21
第四章 實證分析與文獻探討……………………………………………………27
第一節 住院天數 ……..……………………………………………………28
第二節 術後加速康復療程效益 ..…………………………………………30
第三節 全民健康保險 …………………………..…………………………32
第四節 最適肌張力手術輔助處置優缺點 …………………..……………34
第五節 自費醫療與商業保險………………………..…………..…………36
第六節 自費醫療與醫療品質………………………………………………39
第七節 醫病共享決策………………………………………………………41
第五章 結論與建議………………………………………………………………43
第一節 結論…………………………………………………………………43
第二節 建議…………………………………………………………………43
第三節 管理意涵……………………………………………………………46
參考文獻 ..…………………………………………………………………………48

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二、 中文
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侯彥伶. (2020). 醫療科技日新月異　新藥價格高昂－健保應避免走向　「保小病不保大病」黑洞. 禪天下(178), 26-31.
健康世界編輯部. (2022). 麻醉安全也是手術成功的關鍵. 健康世界(545), 53-54.
劉哲瑋. (2022). 進步的內視鏡脊椎融合手術. 健康世界(552), 38-39.
劉燦宏, 任文瑗, 趙嘉成, 崔岡, & 邱文達. (2004). 以顧客關係管理觀點探討自費醫療服務. [A Study of Self-Pay Treatment Service Based on Customer Relationship Management View]. 醫務管理期刊, 5(3), 304-321. doi:10.6174/jhm2004.5(3).304
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蔡甫昌, 楊哲銘, & 吳造中. (2003). 健保給付與病人自願付費之倫理與法律問題. [The Ethical and Legal Issues Concerning Patient's Self-payment Under National Health Insurance]. 台灣醫學, 7(3), 420-424. doi:10.6320/fjm.2003.7(3).15
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三、 網路
李佳欣，(2020)，康健雜誌｢自費醫療經驗大調查｣
彭子珊，(2024)，康健雜誌｢手術前一刻還被推銷　自費浮濫的背後真相｣
楊淑枝，（2021），民眾對麻醉自費醫療的使用意圖之研究，中山大學企業管理學
系醫務管理碩士論文。
戴裕庭，(2017)，麻醉自費醫療項目的創新與發展，國立清華大學高階經營管理
碩士在職專班碩士論文。
保險事業發展中心《202402 保險市場重要指標》，2022年世界各國保險滲透率前20名排行表。https://www.tii.org.tw/export/sites/tii/research/files/11212_Upload_171.pdf