中重度慢性阻塞性肺疾病病人急性呼吸困難症狀發作之身體感知

本研究旨在探討中重度慢性阻塞性肺疾病病人急性呼吸困難症狀發作之身體感知，採現象學研究法，在南臺灣某醫學中心以立意取樣方式徵求十五位個案參與本研究。研究者將所有的訪談內容逐字轉寫成行為過程紀錄，並將紀錄以Colaizzi（1978）的內容分析法進行資料的分析與歸納。資料分析結果顯示中重度慢性阻塞性肺疾病病人急性呼吸困難症狀發作之身體感知，可歸納為：一、身體在呼吸困難時的表述：身體彰顯著對空氣的渴望與無力、體現呼吸的急迫感與閉鎖感、墜落於死亡邊緣的恐懼；二、失序的身體與時間：可見與不可見的身體處境、失序的身體與失去的生理時間控制；三、身體試圖矯正與安撫的措施：身體試圖矯正呼吸取得平衡、身體受到威脅採取應變方法。研究結果顯示：慢性阻塞性肺疾病發展軌跡可能很長，是貫穿整個生命的歷程，隨著疾病的進展，急性發作頻率會增加，嚴重慢性阻塞性肺疾病病人呼吸困難可能變得越來越難以控制，因而交織出獨特的身體經驗。本研究可提供護理人員如何識別和照護慢性阻塞性肺疾病急性呼吸困難發作之參考，並期許未來能提供中重度慢性阻塞性肺疾病病人急性呼吸困難症狀發作時適當的處理。

關鍵字

身體感知；呼吸困難；急性症狀發作；慢性阻塞性肺疾病；質性研究

並列摘要

This study aimed to investigate embodied situations associated with attacks of acute dyspnea symptoms in patients with moderate to severe chronic obstructive pulmonary disease (COPD), and it was conducted by the phenomenological method. This study were 15 patients recruit from a medical center in Southern Taiwan. The content of all the interviews conducted by the researcher were verbatim transcribed into process recording. The data were analyzed by Colaizzi’s(1978) content analysis. The results of the data analysis, the embodied situations were summarized as follows. (1) Embodied expression during dyspnea attacks: The body exhibits yearning for the air and powerlessness and manifests shortness of breath and a feeling of smothering as well as the fear of tumbling on the verge of death. (2) Physical temporal disorder: The body is in disorder and the control over physiological time is lost in both visible and invisible situations. (3) The body’s attempts to corrective and soothing: The body tries to correct breathing to regain balance and take response actions against encountered threats. The results indicate that COPD may have prolonged trajectories that run through the entire life. This study may provide nursing staffs with a reference to identify acute dyspnea attacks and care the COPD patients.