找回慢性阻塞性肺病病人理所當然的呼吸

Regain Taken-for-Granted Breathing in Chronic Obstructive Pulmonary Disease

楊嘉禎(Chia-Chen Yang) ； 王品鈞(Pin-Chun Wang) ； 陳玉如(Yu-Ju Chen)

《源遠護理》 9卷2期 (2015/06) Pp. 11-20

https://doi.org/10.6530/YYN/2015.5.08

摘要

慢性呼吸道疾病、慢性心血管疾病如心臟病及中風、癌症、與第二型糖尿病，同列為即將帶來全球極大的死亡率與殘障率之主要慢性非傳染性疾病（chronic non-communicablediseases）。慢性阻塞性肺部疾病（chronic obstructive pulmonary disease, COPD）因不可治癒且盛行率逐年攀升，被視為慢性呼吸道疾病中危害健康及生活品質、耗費最大醫療資源的疾病。呼吸困難、焦慮、活動耐受力低下是COPD病人之主要症狀，面對症狀困擾病人採取少動或不動的靜態生活，而這些心生理症狀間常形成一個惡性循環，導致生活品質、身體機能下降，以致死亡率提高。GOLD治療指引（global initiative for chronic obstructive lung diseaseguideline）指出肺部復健為穩定COPD病患者的非藥物治療準則之一，證實可改善運動能力、減少呼吸困難感、改善生活品質、減少相關之焦慮及憂鬱及改善存活率等優點。但在台灣，長期執行肺部復健運動的COPD患者比例十分低，即使經過運動訓練計畫，而能持續者亦非常的罕見，使得復健訓練帶來的好處，將隨著時間漸漸消失。因此為使COPD病人能提高運動自我效能，以持續進行規律的肺部復健運動，被國際視為照護這類病人的重要議題。

關鍵字

慢性阻塞性肺部疾病 ； 呼吸困難 ； 焦慮 ； 肺部復健 ； 自我效能

並列摘要

Improving patients' self-efficacy and regular exercise are important global issues regarding the care of patients with chronic obstructive pulmonary disease (COPD). Leading the impact on global mortality and morbidity caused by chronic non-communicable disease (CNCD) are COPD, heart disease, stroke, cancer, and type II diabetes. COPD is incurable and continues to increase in prevalence. The main symptoms of COPD include dyspnea, anxiety, and poor activity, leading to a vicious cyrcle of lower quality of life, decline physical function and increased mortality. A global initiative for chronic obstructive lung disease (GOLD) Guideline has suggested pulmonary rehabilitation as an evidence-based non-pharmacological standard therapy to stabilize COPD patients. It claims to improve the patients' exercise capacity, quality of life and survival rate. It also reduces the sense of difficulty breathing, anxiety and depression. Challenges remain; after initial rehabilitation training, it is hard to maintain a COPD patient's drive to continue regular and long-term exercise.

並列關鍵字

chronic obstructive pulmonary disease ； dyspnea ； anxiety ； pulmonary rehabilitation ； self-efficacy

參考文獻

李佳諭、葉莉莉、陳炯睿、林佩宜、薛尊仁、王文玲（2008）．慢性阻塞性肺疾患者自我管理行為之探討．護理雜誌，55（5），45-55。doi:10.6224/JN.55.5.45

陳乃釧、蘇千玲、彭雪雲、沈建業（2009）．慢性阻塞性肺疾病患者之飲食營養．台灣呼吸治療雜誌，8（1），63-74。doi:10.6269/JRT.2009.8.1.06

Majothi, S., Jolly, K., Heneghan, N. R., Price, M. J., Riley, R. D., Turner, A. M., ... Jordan, R. E. (2015). Supported self-management for patients with COPD who have recently been discharged from hospital: A systematic review and me-ta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, 10, 853-867. doi:10.2147/COPD.S74162

Mannino, D. M., & Buist, A. S. (2007). Global bur-den of COPD: Risk factors, prevalence, and fu-ture trends. Lancet, 370(9589), 765-773. doi:10.1016/S0140-6736(07)61380-4

McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews, 2, CD003793. doi:10.1002/14651858.CD003793.pub3