Pulmonary Dysfunction in Residents of Chronic Care Facilities

慢性療養機構住民之肺功能評估

王亭貴(Tyng-Guey Wang) ； 約翰．巴哈(John R. Bach)

《中華民國復健醫學會雜誌》 21期 (1993/12) Pp. 67-73

摘要

肺功能異常是導致慢性療養機構住民活動能力降低的原因之一。在慢性療養機構的住民或因老化現象，或因罹患慢性阻塞性肺疾病，或因有神經肌肉病變，常會有肺功能的異常。但因平時活動有限，不易顯現呼吸系統症狀，易被醫護人員忽略，而沒有及早處理。本文即探討這群住民肺功能異常的嚴重度及提出適當的評估及治療方式。
本研究是以36名慢性療養機構住民為對象，其中12名曾被診斷為慢性阻塞性肺疾病，19名有神經肌肉病變或中樞神經損傷，5名為大於80歲之老人。所有36名受試都接受肺功能檢查。利用PULSEscale來評估受試自我照顧及活動的能力，以Spearman rank相關分析來檢定受試自我照顧及活動能力障礙和肺功能異常的關係。
結果顯示所有受試在接受肺功能測試時，主觀上都沒有呼吸系統的症狀，但肺功能檢查都表現出明顯的限制性肺疾病證據。（其呼氣容積都小於預測值之80%）。他們自我照顧和活動能力的障礙和限制性肺疾病之嚴重程度成正相關。所有受試的呼吸肌力，呼吸肌耐力及排除分泌物之能力都有明顯下降的現象。這些呼吸功能的不足使得他們即使只是面對一般的呼吸道感染，也無法有效地克服，而易形成肺部的合併症。早期找出這群高危險住民潛在之肺功能異常，給予適當地胸腔復健，或者利用非侵襲性的呼吸器具幫助他們渡過急性呼吸道感染，是減低這群住民肺罹病率及死亡率的不二法門。

並列摘要

The study was designed to determine the extent of significant pulmonary　dysfunction in selected residents of chronic care facilities, to find out any relationhip between pulmonary dysfunction and general disability, and explore pulmonary treatment options.
Thirty-six nursing facility residents over 80 year old, or with a diagnosis of chronic obstructive pulmonary disease or generalized neurological or neuromuscular disease, were surveyed for extent of disability and pulmonary dysfunction. By comparison with age, height, and sex norms, there were significant restrictive pulmonary syndrome, poor inspiratory muscle strength and endurance and inadequate airway secretion clearance mechanisms in all of the residents studied. In addition, at least eight residents manifested chronic alveolar hypoventilation. Four residents with severe restrictive pulmonary syndromes were misdiagnosed as having chronic obstructive pulmonary disease. The extent of pulmonaary dysfunction significantly correlated with the extent of general disability.
We conclude that chronic alveolar hypoventilation and respiratory muscle insufficiency appear to be under diagnosed and under treated in residents of chronic care facilities. The failure to institute appropriate nonivasive interventions may lead to increased pulmonary morbidity in this patient population.

並列關鍵字

geriatric medicine ； pulmonary function ； respiratory insufficiency ； pulomonary rehabilitation