物理治療處理之急性心肌梗塞個案報告－「國際健康功能與身心障礙分類系統」之應用

A Case Report of Physical Therapy Intervention of Acute Myocardial Infarction-Application of International Classification of Functioning, Disability and Health (ICF) Model

李雨軒(Yu-Hsuan Li) ； 蕭淑芳(Shu-Fang Hsiao) ； 廖華芳(Hua-Fang Liao) ； 簡盟月(Meng-Yueh Chien)

《物理治療》 38卷2期 (2013/06) Pp. 116-125

摘要

心臟疾病高居台灣地區十大死因第二名，其中最嚴重的是急性心肌硬塞，死亡率約10%-20%。隨著醫療技術進步，心肌硬塞患者的死亡率下降，但患者後續的日常生活功能與品質以及二次預防是更重要的議題。本文將利用「個案處理模式」與「國際健康功能與身心障礙分類系統」(ICF)進行急性心肌硬塞個案分析。本文個案是一名的43歲男性，在2012年8月因左胸突發性劇痛被送往醫院診治。心電圖檢查結果顯示V1-4導極出現超急性T波，心導管檢查顯示左前降枝、右冠狀動脈和左旋枝分別有100%、30%和80%阻塞，診斷為急性心肌硬塞。於是進行經皮氣球擴張冠狀動脈支架成型術，並使用葉克膜和主動脈內氣球幫浦維持心臟功能。病發後6天開始第一期心臟復健計畫，並於住院13日後出院。經轉介，在出院後7日開始接受第二期心臟復健計畫。採用ICF分析後發現，個案主要問題在於心血管系統功能不良，導致運動耐受力下降，影響患者日常工作，並且造成心理壓力與焦慮。而患者有許多心血管疾病的高危險因子，可能導致冠狀動脈疾病再發生。物理治療根據過去文獻推論並採用心臟復健計畫以有效改善患者運動耐受力，促進生活品質，並減少再發生率。經過二個月物理治療介入後，個案的最大運動能力和主要肌肉力量顯著增加，焦慮狀態也有改善，個案積極復健並配合日常生活型態的調整，已重返工作。

關鍵字

急性心肌硬塞 ； 冠狀動脈心臟病 ； 心臟復健 ； 個案處理模式 ； 國際健康功能與身心障礙分類系統

並列摘要

Acute myocardial infarction (AMI) is the most prevalent fatal heart disease worldwide. The mortality rate of AMI is approximately 10% to 20%. Although the advances in medical technology lower the mortality rate of myocardial infarction, the subsequent functional capacity and quality of life, and secondary prevention of the survivors are the important issues. This article analyzed a case diagnosed with AMI by using the Client Management Model (CMM) and International Classification of Functioning, Disability and Health (ICF). The case is a 43-yearold man diagnosed as AMI. He suffered from sudden severe left chest pain on August 2012, and was then sent to a teaching hospital for treatment. At the emergency room, the electrocardiogram revealed hyperacute T wave over V1-4 and coronary angiography revealed multiple occlusions of three coronary arteries. Under the diagnosis of AMI, the percutaneous balloon obstructive stent plastic surgery (POBAS) was performed. In addition, both extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) were used to improve cardiac function. Cardiac rehabilitation phase I program was started on the 7th day after onset and he was discharged under stable medical condition after 13-day hospitalization. The patient has started cardiac rehabilitation phase II program in the physical therapy department after discharged from the hospital 27 days. ”The International Classification of Functioning, Disability and Health” (ICF) model was used for comprehensively describing and classifying health status and its related factors of this patient. We found that the key problem of this patient was cardio-vascular dysfunction which led to exercise intolerance, functional impairment, and anxiety. In addition, the patient had several risk factors associated with cardiovascular disease. Physical therapy goal, and intervention were based on strong evidences supported that cardiac rehabilitation phase II program could improve exercise capacity and quality of life of patients after AMI. After two-month physical therapy intervention, the patient got significant improvement of maximal exercise capacity and muscle strength, and decrement of anxiety. The patient also showed high motivation to continue the cardiac rehabilitation program and has returned to work.

並列關鍵字

Acute myocardial infarction ； Coronary heart disease ； Cardiac rehabilitation ； Patient/Client management model ； ICF