- 學位論文
探討使用誘導性肺計量器及上肢運動訓練對心臟瓣膜手術病人術後肺部功能成效
The Effect of Using Incentive Spirometer and Upper Limb Exercise Training Preoperative on Lung Function in Cardiac Surgery Patients
摘要
研究背景：心臟手術是一個高度複雜的手術過程，會導致肺功能惡化並降低吸氣肌力量，而最常見是肺擴張不全及肺炎。吸氣的肌肉訓練成效是影響心臟手術後肺部早期功能的重要決定因素，誘導性肺計量器（Incentive spirometer, IS）是運用吸氣儲備容積，因而改善吸氣肌的效率。運用上肢進行運動訓練將有效擴張胸廓並改善這些呼吸肌群的肌力和耐力，而增加肺容積，避免肺部塌陷。 研究目的：探討心臟手術患者術前使用誘導性肺計量器及上肢運動訓練對於肺功能、肺部合併症發生率、插管時間與住院天數的影響。 研究方法： 本研究採介入性設計，樣本以隨機分派方式分為介入組與控制組，兩組各為30人。對照組接受常規術前照護，實驗組接受術前為期二週的誘導性肺計量器及上肢運動訓練。將研究資料以SPSS 22.0版進行資料統計分析，以獨立樣本t檢定，比較兩組病患在肺功能、肺部合併症發生率、拔管時間及住院天數之差異。 研究結果：兩組人口學及疾病屬性資料並無顯著差異；在實驗組之肺部合併症發生率是低於對照組（P<0.031）；在插管時間方面，實驗組顯著低於對照組（P<0.003）；兩組之肺功能及住院天數無顯著差異。 結論：心臟瓣膜手術病患在使用誘導性肺計量器及上肢運動訓練確實能降低肺部合併症發生及縮短住院天數，亦可縮短患者手術後復原時間及減低因手術後相關併發症產生之醫療成本負擔；使用誘導性肺計量器及上肢運動訓練之患者，易可感受到醫療人員鼓勵及關心，並建議設計訓練成效之具體方案，來增加病患訓練之動機，進而提升照護品質。
並列摘要
Background: Cardiac surgery is a highly complex surgical procedure that can lead to deterioration of lung function and reduced inspiratory muscle strength. The most common are atelectasis and pneumonia. The effectiveness of inspiratory muscle training is an essential determinant of early lung function after cardiac surgery. An incentive spirometer (IS) activates the inspiratory reserve volume to improve the efficiency of the inspiratory muscles. Exercise training using the upper extremities will effectively expand the thorax and improve the strength and endurance of these respiratory muscle groups, thereby increasing lung volume and avoiding lung collapse. Purpose of the study: To investigate the effects of the preoperative spirometer and upper limb exercise training for pulmonary function, incidences of pulmonary complications, extubation time, and length of hospital stay in patients undergoing cardiac surgery. Research method: This study adopts an interventional design, and the samples are randomly divided into an intervention group and a control group randomly by computer, with 30 people in each group. The control group received routine care before the operation, and the experimental group received a two-week induction spirometer and upper limb exercise training. Statistical analysis of the research data was carried out with SPSS version 22.0, and independent samples t-test was used to compare the differences in lung function, the incidence of pulmonary complications, extubation time, and hospitalization days between the two groups. Research results: There was no significant difference in demographics and disease attributes between the two groups; the incidence of pulmonary complications in the experimental group was lower than that in the control group (P<0.031); in terms of intubation time, the experimental group was significantly lower than the control group (P<0.003); there was no significant difference between the two groups in lung function and length of hospitalization compared with the control group. Conclusion: The use of induction spirometer and upper limb exercise training in patients undergoing heart valve surgery can indeed reduce the incidence of pulmonary complications and shorten the length of hospitalization, and can also shorten the postoperative recovery time of patients and reduce the medical expenses caused by postoperative complications. Cost burden; patients who use induction spirometers and upper limb exercise training can quickly feel the encouragement and care of medical staff and suggest designing specific training programs to increase patients' motivation for training and improve the quality of care.