運用風扇緩解呼吸困難－系統性文獻回顧與臨床應用

背景：呼吸困難為主觀不適感受，末期病人於生命最後幾週常遭受此症狀之苦，臨床上已開始運用風扇緩解末期病人之呼吸困難，但未有一致性操作，且缺乏系統性文獻回顧探討其成效。目的：探討運用風扇緩解呼吸困難之成效與臨床應用。方法：採系統性文獻回顧法，搜尋從資料庫開始收錄至2017年9月前，發表於PubMed、CINAHL、MEDLINE、PsycINFO及Cochrane CENTRAL資料庫，運用PICO（participant, intervention, comparison, outcome）設立關鍵字與同義字為呼吸困難、喘、呼吸急促、吸不到氣、呼吸費力、風扇及量表等，搜尋出41篇文獻，經篩選、刪除重複及評讀後，納入3篇符合主題之隨機控制試驗進行分析，GRADE（grading of recommendations assessment, development and evaluation）證據品質為中等級。結果：符合納入條件的文章共3篇，系統性回顧結果顯示運用風扇以低風速朝臉部三叉神經第二和三分支吹拂5分鐘，距離以病人舒適為主，於患者呼吸困難發作時立即使用，比僅使用藥物和氧氣治療能有效減緩非缺氧性呼吸困難患者（包括心肺疾病、癌症等）的呼吸困難主觀感受。結論／實務應用：非缺氧性呼吸困難病人之緩解症狀應以減輕病人「喘的感覺」為優先。風扇減緩呼吸困難為具實證基礎、非侵入性、經濟及有效的非藥物療法。

關鍵字

呼吸困難；風扇；系統性文獻回顧

並列摘要

Background: Dyspnea is a subjective symptom of breathing discomfort that is commonly experienced by terminally ill patients in the last few weeks of life. Fans have been used to reduce breathlessness in clinical practice for terminally ill patients. However, reviews in the systematic literature are insufficient to make definite conclusions regarding the effectiveness of this intervention and to provide a consistent protocol for clinical application. Purpose: The purpose of the present study was to evaluate the effects and clinical application of using fans in dyspnea patients. Methods: A systematic review was used. Relevant articles published prior to September 2017 were retrieved from electronic databases including PubMed, CINAHL, MEDLINE, PsycINFO, and Cochrane CENTRAL. Keywords and MeSH terms were identified for each PICO (participant, intervention, comparison, outcome) element, including dyspnea, breathless, breath shortness, breathing difficulty or labored respiration, fan, and scale. A total of 41 articles that matched the search criteria were extracted. After screening the topics, deleting repetitions, and doing critical appraisals, three randomized controlled trials were selected for further analysis. The GRADE (grading of recommendations assessment, development and evaluation) quality of evidence rating was intermediate. Results: The systematic review of the three articles revealed that a fan set at low speed with facial cooling of the 2nd and 3rd branches of the trigeminal nerve as soon as possible for 5 minutes and at a distance that is comfortable for the participant may relieve subjective feelings of dyspnea in nonhypoxic patients (e.g., cardiopulmonary disease and cancer) better than drugs and oxygen treatment alone. Conclusions/Implications for Practice: Reducing the subjective feelings of dyspnea is the first step for nonhypoxic patients. Using a fan to relieve dyspnea is an evidence-based, non-invasive, economical, and effective nonpharmacological palliative intervention.

並列關鍵字

dyspnea ； fan ； systematic review

參考文獻

Ander, D. S., Aisiku, I. P., Ratcliff, J. J., Todd, K. H., & Gotsch, K. (2004). Measuring the dyspnea of decompensated heart failure with a visual analog scale: How much improvement is meaningful? Congestive Heart Failure, 10(4), 188–191. https://doi.org/10.1111/j.1527-5299.2004.03475.x

Bausewein, C., Farquhar, M., Booth, S., Gysels, M., & Higginson, I. J. (2007). Measurement of breathlessness in advanced disease: A systematic review. Respiratory Medicine, 101(3), 399–410. https://doi.org/10.1016/j.rmed.2006.07.003

Bausewein, C., Booth, S., Gysels, M., & Higginson, I. J. (2008). Non- pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Systemic Review, 1, Art. No.: CD005623. https://doi.org/10.1002/14651858.CD005623

Bausewein, C., Booth, S., Gysels, M., Kühnbach, R., & Higginson, I. J. (2010). Effectiveness of a hand-held fan for breathlessness: A randomised phase II trial. BMC Palliative Care, 9(1), article 22. https://doi.org/10.1186/1472-684x-9-22

Booth, S., Moosavi, S. H., & Higginson, I. J. (2008). The etiology and management of intractable breathlessness in patients with advanced cancer: A systematic review of pharmacological therapy. Nature Clinical Practice Oncology, 5(2), 90–100. https://doi.org/10.1038/ncponc1034

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運用風扇緩解呼吸困難－系統性文獻回顧與臨床應用

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