探討開心手術術後病患接受上肢運動後呼吸肌強度、疲憊感與脫離呼吸器之成效

研究背景：心臟血管疾病位居國人十大死因第二位，心臟手術術後最常發生肺部合併症，且微創心臟手術術後經常發生併發症為再擴張性肺水腫，導致患者肺部復健困難度增加，無法脫離呼吸器，延長住院天數，可運用上肢運動訓練以增強呼吸肌強度，促進肺部擴張和咳嗽功能，減少肺部合併症發生，盡早脫離呼吸器，減少住院天數。研究目的：探討開心手術術後病患介入上肢運動後呼吸肌強度、疲憊感與脫離呼吸器之成效及其相關因素。研究方法：隨機分派臨床試驗，實驗組病患於術後隔日開始上肢運動訓練和常規心肺復健，控制組則於術後隔日開始常規心肺復健訓練。將研究資料以 SPSS 25.0版進行資料統計分析，以無母數檢定-2個獨立樣本，比較兩組呼吸肌強度、疲憊感、拔管時間及加護病房住院時間之差異。研究結果：兩組人口學及疾病屬性資料並無顯著差異，兩組呼吸肌強度、拔管時間及加護病房住院時間皆無顯著差異；疲憊感術前、術後24小時無顯著差異，術後第五天有顯著差異(P＝0.04)。結論：因樣本數較少，統計學上無法有顯著差異，但發現開心手術後介入上肢運動訓練仍有增加呼吸肌強度，並加速脫離呼吸器時間減少插管之不適，並可減少加護病房住院時間，降低加護病房佔床率且減少醫療成本。參與此研究時發現藉由訓練過程，給予適當衛教，促使病患訓練意願，可提升肺部功能和降低發生肺部併發症。

關鍵字

開心手術；上肢運動訓練；呼吸肌強度；疲憊感

並列摘要

Background: Minimally invasive cardiac surgery complications is re-expansion pulmonary edema, upper limb exercises to increase the respiratory muscle strength and lung expansion and cough function, reduce of pulmonary complications, weaning ventilator, and reduce hospitalization days. Purpose of the study: Exploring the effect of respiratory muscle strength, fatigue and weaning ventilation after upper limbs exercise in patients with cardiac surgery. Method: Randomized clinical trial. Experimental group received cardiopulmonary rehabilitation and upper limb exercise training after surgery, control group received cardiopulmonary rehabilitation after surgery. Statistical analysis of the research data was carried out with SPSS version 25.0, and Mann-Whitney U were used to compare the differences in respiratory muscle strength, fatigue, extubation and intensive care unit length of stay. Results: There was no significant difference in demographics and disease attributes between the two groups, and there were no significant differences in respiratory muscle strength, extubation, and intensive care unit length of stay; there was no significant difference in fatigue before and after 24 hours, and the experimental group was significantly lower than the control group in fifth postoperative Days (P = 0.04). Conclusion: Due to the small number of samples, there is no statistically significant difference. However, the intervention of upper limb exercise training can increase the strength of respiratory muscles, extubation, and reduce the length of stay in the intensive care unit, reduce the bed occupancy rate of the intensive care unit and reduce medical costs after cardiac surgery.