肺復原於肺阻塞患者之應用

Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease

蔡毓真(Yu-Chen Tsai) ； 許端容(Tuan-Jung Hsu) ； 王嫈媖(Yin-Ying Wang) ； 洪仁宇(Jen-Yu Hung) ； 蔡忠榮(Jong-Rung Tsai)

《內科學誌》 32卷6期 (2021/12) Pp. 385-397

https://doi.org/10.6314/JIMT.202112_32(6).01

摘要

肺阻塞是肺臟長期慢性發炎導致呼吸道與肺實質受損，造成持續性氣流受阻的疾病。除了影響呼吸系統，也常合併許多系統性共病，造成診斷及治療上的困難。肺阻塞病人常表現慢性咳嗽、有痰、呼吸困難，引發焦慮及憂鬱，降低運動耐受性及身體活動度，形成惡性循環，導致死亡。穩定期的肺阻塞治療目標為減輕症狀及降低疾病惡化、急性發作及死亡之風險，除了支氣管擴張藥物，應再合併非藥物治療。肺復原是以病人為中心的個人化長期整合照護介入計畫，是肺阻塞重要的非藥物治療項目之一，適用於在接受藥物及其他治療後症狀仍難以緩解的肺阻塞及慢性呼吸道疾病患者。肺復原包括呼吸訓練、運動訓練、衛教與健康行為促進。呼吸訓練包括痰液清除及呼吸咳嗽訓練、肺擴張治療、使用節能技巧或輔助工具。運動訓練以下肢高強度耐力運動為主，並視情況加入上肢運動、阻力訓練、神經肌肉電刺激、呼吸肌訓練、或全身震動治療等。肺復原團隊依據呼吸問題擬定全面性個人化介入計畫，希望能協助建立最佳照護決策，以減緩病情惡化與急性發作的機率，並改善健康相關的生活品質和存活率。

關鍵字

肺復原（Pulmonary rehabilitation） ； 肺阻塞／慢性阻塞性肺病（Chronic obstructive pulmonary disease, COPD） ； 慢性呼吸道疾病（Chronic airway disorder）

並列摘要

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation caused by chronic airway inflammation. Besides, there are several systemic co-morbidities, which make the diagnosis and treatment more difficult. The COPD patients often present with chronic cough, productive sputum, dyspnea, which lead to anxiety or depression, then decreased exercise tolerance and physical activity. The vicious cycle will contribute to more acute exacerbation and mortality. Thus, the treatment goal for stable COPD is to reduce symptoms and the risk for acute exacerbation. The COPD treatment included pharmacologic and non- pharmacologic therapy. Pulmonary rehabilitation is an important non-pharmacologic therapy for COPD. It is a patient-centered, long-term, integrated plan for patients with refractory symptoms despite other medical treatment. Pulmonary rehabilitation included respiratory training, exercise training, and health education. The respiratory training included breath control, sputum clearance, and lung expansion therapy to reduce air trapping. The exercise training focus on the high intensive endurance exercise of the lower limbs, and adds on training of upper limbs, resistance training, neuromuscular stimulation, respiratory muscle training, or whole body vibration depending on the individual situation. The pulmonary rehabilitation establishes the integrated program for the optimal care of symptomatic patients, reduces the risk of exacerbation, and improves the health-related quality of life.