脊髓損傷患者脊髓的損傷程度與其適能之相關性

脊髓損傷患者因僅留上下肢少數肌肉可做耐力性或暴發力性的運動，其心肺功能較難維持。本研究乃探討此類患者脊髓損傷部位高低、損傷程度與心肺功能、日常生活功能、上肢肌力的相關性。先收集符合American Spinal Cord Injury Association (ASIA), impairment scale A.B.C的脊髓損傷病患，再依International Impairment Classification (British Medical Research Council, MRC) class IA-6分類，取其中class IB-4級。測試項目包括(1)靜態肺功能：spirometry，最大自主性換氣量(maximal voluntary ventilation)、肺活量(slow vital capacity)，(2)動態肺功能： continuous graded exercise, arm-cranking ergometry, (3)上肢肌力測試：等速肌力(isokinetic test)及手握力(handgrip power)。在上肢肌力測試方面Index of overall muscular strength = (elbow flexion + elbow extension + shoulder flexion + shoulder extension) / 4，日常生活功能以functional independence measurement (FIM)評估。全部所得結果以ANOVA, Pearson correlation分析。結果共收集脊髓損傷無法行走的患者63位，class IB有10位，class 2 (T1~T5)有10位，class 3 (T6~T10)有12位，class 4 (T11~L3)有31位。(1)在上肢手搖機運動方面，IB class 所得的最高攝氧量(peak VO2)、最高攝氧量預測值百分比[peak VO2(%, pred)]、最大運動瓦數(peak work rate)、最大運動瓦數預測值百分比[peak work(%, pred)]，最高心率[peak heart rate(HR)]、最高心率預測值百分比[peak HR(%, pred)]、手握力、自我照顧能力(self care)和移動能力(mobilility)均較其它3組低。(2)以ANOVA分析得知肺功能中的用力肺活量(forced vital capacity, FVC), FVC(%, pred),第一秒最大吐氣量(forced expiratory volume in first second, FEV1), FEV1(%, pred)，上肢手搖機運動所得的最高攝氧量、最高攝氧量預測值百分比、最大運動瓦數(peak work rate)、最大運動瓦數預測值百分比[peak work (%, pred)]、最高心率[peak heart rate(HR)]、最高心率預測值百分比[peak HR(%, pred)]、手握力、自我照顧能力和移動能力與脊髓損傷部位的高低有顯著的相關。(3)用力肺活量、第一秒最大吐氣量、最大自主性換氣量、肺活量和等速肌力、最大運動瓦數、最高攝氧量和手握力亦有顯著相關。(4)以Pearson correlation分析得知最高攝氧量與等速肌力測試所得的最大力矩(peak torque)、全部功(total work)、平均功率(average work rate)和手握力有顯著的相關性。故研究得知脊髓損傷患者的動靜態肺功能、等速肌力、功能性能力和握力不僅和脊髓損傷部位有密切關係，而它們彼此之間更是息息相關，故對脊髓損傷患者的完整計劃應包括上述各方面。

關鍵字

脊髓損傷；功能獨立量表；心肺功能測試；肌力

並列摘要

The daily activities of patients with spinal cord injury (SCI), especially those of quadriplegics or non-ambulatory SCI patients, are usually inadequate to maintain physical fitness. Lack of participation in a regular activity program may result in a debilitative cycle. Therefore, cardiopulmonary problems rank high in these patients during the acute stage and also the later years. The purpose of this study is to investigate the correlation between neurological impairment, cardiopulmonary function, upper limbs muscle strength and functional capacity in the patients. Sixty-three subjects were enrolled according to the American spinal cord injury association (ASIA) impairment scale A,B,C and then separated into 4 groups (classes 1B-4) according to the International Impairment Classification of the British Medical Research Council. There were 10 cases in class IB, 10 cases in class 2 (T1-T5), 12 cases in class 3(T6-T10) and 31 cases in class 4 (T11-L3). Fitness measurements included spirometry, slow vital capacity, maximal voluntary ventilation (MVV), peak oxygen uptake (peak VO2), peak work, peak heart rate (HR) peak torque, average power, total work of upper limb of isokinetic test, handgrip power, and scores of self-care and mobility of functional independence measure. One-way ANOVA, Pearson correlation and stepwise regression were used for statistical analysis. The results showed that FVC (forced vital capacity)，FVC (%, pred)，FEV1(％, pred），peak VO2 (%, pred)，peak work，peak work (%, pred)，peak heart rate (HR)，peak HR (%, pred), handgrip, self-care and mobility were significantly correlated with the level of SCI. And FVC, FEV1, MVV and SVC had also correlated with isokinetic muscle strengh, peak work, peak VO2 and hand grip strength. The peak VO2 was correlated with peak torque, total work, average power, and handgrip strength of bilateral upper limbs. The results showed close relationship between the SCI level, cardiopulmonary function, isokinetic muscle strength and functional ability. Therefore, it emphasized that a systemic exercise-conditioning program is very important for non-ambulatory SCI patients.

並列關鍵字

spinal cord injury ； functional independence measurement ； cardiopulmonary functional test ； muscle strength

被引用紀錄

徐維停（2011）。脊髓損傷者生涯信念與成功就業之相關性研究〔碩士論文，國立臺灣師範大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0021-1610201315230661

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脊髓損傷患者脊髓的損傷程度與其適能之相關性

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