自發性引流對呼吸道清除成效之探討

The Efficiency of Autogenic Drainage on the Airway Clearance

顧佩芬(P. F. Ku) ； 高紀惠(C. H. Kao) ； 郭漢彬(H. P. Kuo)

《長庚護理》 6卷2期 (1995/12) Pp. 1-12

摘要

呼吸澄清除功能障礙是許多呼吸道疾病病人共有的問題，也是衍生各種合併症的主因。本研究針對某醫學中心門診之支氣管擴張症病人施行痰液清除方案，以探討自發性引流改善痰液清除能力之成效。研究設計採凖實驗法，依就診先後次序及選樣條件選取實驗組與對照組各23人。研究者利用衛教手冊時進行姿勢引流與自發性引流指導，實驗組於第一週接受姿勢引流指導，第五週接受自發性引流指導，對照般只於第一週接受姿勢引流指導。
研究結果顯示：(1)兩組之基本資料無顯著差異。(2)實驗組與對照組之咳痰難易度皆有顯著改善，實驗組之咳痰難易度較對照組明顯改善，即自發性引流能明顯改善咳痰難易度，增進痰液消除能力。(3)兩組病人之肺功能改善程度無顯著差異，但實驗組能顯著減少肺部死腔、增進肺瀰散量、和改善呼吸道阻塞程度，而對照組只能增進肺瀰散量。(4)實驗組走路六分鐘距離與對照組均有顯著改善。比較兩組之呼吸道氣體滯留程度、走路六分鍾距離、運動時最低血氧濃度和呼吸困難程度均無顯著差異，即兩組病人在活動耐力方面無顯著差異。(5)痰液清除能力愈好，則肺功能愈好，活動耐力也因肺功能的改善而獲得改善。
由此可知，簡便易學的自發性性引流能有效清除痰液，適於呼吸道清除功能障礙病人居家照護的推廣。

關鍵字

自發性引流 ； 姿勢引流 ； 痰液清除能力 ； 肺功能 ； 活動耐力

並列摘要

Airway clearance dysfunction is a common problem for patients with various airway disease, and continues to be a major cause contributing to various complications. In this study, sputum clearance measures was conducted on patients with bronchiectasis to investigate the efficiency of sputum clearance with autogenic drainage (AD). Patients were recruited from out-patient clinics in a medical center to either experimental or control groups. Patients in experimental group received instruction of postural drainage (PD) in first week and AD in fifth week, while control group received instruction of PD in first week only.
Results of the study showed (1) There was no significant difference in demographic data between experimental (n=23) and control (n=23) groups. (2) In sputum clearance, ease of expectoration was improved in experimental and control groups, but more significantly in experimental group. (3) There was no significant difference in the changes of pulmonary function tests between experimental and control groups. However, AD could reduce dead space, increase pulmonary diffusion capacity and improve airway obstruction, while PD would increase diffusion capacity only. (4) In the aspect of activity tolerance, six-minute walking distance was increased in both groups. No significant difference could be found between the two groups. (5) More improved in sputum clearance, more improved pulmonary function would be and in turn, activity tolerance would further be augmented.
Obviously, the autogenic drainage is a simple and easy-to-learn measure which can clear sputum effectively, and deserves promotion for home care of patients with difficulty in airway clearance.

並列關鍵字

autogenic drainage ； postural drainage ； sputum clearance ； pulmonary function ； exercise tolerance