居家步行運動訓練對周邊動脈疾病患者血管功能、行走功能、與生活品質之成效

The effect of a home-based exercise program on vascular function, walking ability and quality of life among patients with peripheral arterial disease

陳玉雯(Yu-Wen Chen)

指導教授 ： 蔡仁貞

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00128

摘要

周邊動脈疾病在老年化的社會中也是一項重要的問題，周邊動脈疾病形成原因主要和動脈粥狀硬化有關，造成下肢的血管內徑逐漸狹窄，因此患者在活動行走會因血流不足而有間歇性跛行，造成下肢休息痛、冰冷、麻痺而影響行走，因此為增進周邊動脈疾病患者的血管功能，增加行走能力以提高生活品質是一項很重要的課題，本研究旨在了解居家步行運動對於血管功能、行走功能、生活品質的成效及其相關性。
本研究共收31位經醫師診斷周邊動脈疾病患者，以隨機方法分配至實驗組16位與對照組15位，實驗組接受為期12週的居家步行運動訓練，對照組則維持原來生活型態，兩組均於第6週及12週接受所有參數之評估，包括基本資料、及填寫行走功能損傷量表及生活品質量表，之後由研究者協助個案進行血管功能測試，（包括血流的測量、及血流調節臂血管擴張變化程度）、行走功能評估（包括跑步機測試開始間歇性跛行時間、最大間歇性跛行時間、6分鐘行走測試）。上述資料以SPSS17.0版進行建檔及分析，包括Pearson's correlation、GEE等推論性統計分析方法，所有統計的檢定significant level定為p＜ .05，以評估居家運動訓練對周邊動脈疾病患者血管功能、行走能力及生活品質之影響。
結果實驗組的血流調節血管擴張程度介入前為7.7 %，經12周居家步行運動訓練為10.83 %，增加0.4 %（p < .01）。在行走功能方面，實驗組的六分鐘行走功能測試經第12周居家步行運動訓練，增加147.2 %（p < .01），在疼痛/跛行發生時間測量和最大跛行發生時間之結果，增加160 %和145.8 %（p < .01），在行走損傷量表實驗組在症狀加權得分、行走距離、行走速度、上下樓梯、總分，皆比對照組有顯著改善（p < .01）。在血管生活品質量表，實驗組在症狀、情緒、社交活動得分，也有顯著改善（p < .01）。在相關性方面，血流血管擴張的改變量與行走功能損傷問卷行走距離和上下樓梯的改變量有顯著正相關（r = .44, r = .29 ），也和六分鐘行走距離、疼痛發生時間、最大疼痛時間有顯著正相關（r = .45, r = .44, r = .47），血流調節臂血管擴張的改變量與生活品質的問卷分數的活動改變量有顯著負相關（r = .- .27），行走功能改變和生活品質也有顯著負相關。因此實驗組於接受12周居家步行運動後對於血管內皮功能、行走功能、生活品質相較於控制組有統計上有顯著的成效，可作為國內周邊動脈疾病患者居家運動的參考，並應用推廣於臨床。

關鍵字

周邊動脈疾病 ； 血管功能 ； 行走功能 ； 生活品質 ； 居家步行運動訓練

並列摘要

Peripheral arterial disease (PAD) is a chronic obstructive disorder affecting the peripheral arteries. It is ususally caused by atherosclerosis. Since age is a significant predictor for arterial atherosclerosis, prevalence of PAD increases dramatically in the elderly population.
There are five typical symptoms of PAD: pain, pulselss, pallor, paralysis, and paresthesia. Patients who have PAD initially present with pain in the calf and thigh. This causes the manifestation of intermittent claudication. As the disease progress, ischemic rest pain, ulceration or gangrene maybe present at the advanced stage of the disease. The pathophysiology of PAD is due to decrease blood flow in peripheral arteries. Therefore, it is important to modify peripheral vascular perfusion, which in turn to promotes walking ability and improves quality of life in patients with PAD. Purpose of this study were to verify the effect of a home-based exercise program on vascular function, walking ability and quality of life among patients with peripheral arterial disease and to investigate the relationship between these variable.
Patients diagnosed with PAD were included and assigned into two groups. All subjects were asked to maintain their life style, diet, and medical drug during the study period. That home-based exercise program was conducted in the experimental group but not the control group. Arterial function tests for lower limbs and walking ability assessment were performed for all subjects. Walking ability was assessed using the walking impairment questionnaire（WIQ）, maximal claudication time initial claudication time, and the vascular quality of life questionnaire. Patients underwent the measurements at baseline (before the exercise program),6 weeks,and12 weeks after starting the program. Statistical analysis of the data was performed using the Spearman correlation and GEE.A P value < .05 was considered statistically significant.
There were no significant difference in blood flow, pulsatility index and resistance index between the two groups. In experimental group, there were significant benefits in flow-mediated dilatation(FMD), walking ability and quality of life after the exercise program. After 12 weeks, the improvement for six minute walking distance, initial claudication distance, and absolute claudication distance were 147.2 % , 160 % and 145.8 % respectively. Our results showed a positive correlation between FMD and walking ability, and a negative correlation between FMD and quality of life.
This study supports that home-base exercise training could significantly improve FMD, walking time and ability, as well as quality of life in PAD patients. The results would help to apply and facilitate the application of home-based exercise training to help the PAD population.

並列關鍵字

peripheral arterial disease, ； arterial function ； walking ability ； quality of life, ； home –based exercise training

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