長期使用呼吸器個案之物理治療

Physical Therapy in Patients with Prolonged Mechanical Ventilation

吳英黛(Ying-Tai Wu)

《物理治療》 32卷2期 (2007/04) Pp. 59-71

摘要

長期呼吸器使用者整合照護計畫，將呼吸器使用患者劃分為加護病房、呼吸照護中心、呼吸照護病房及居家呼吸照護四個階段。醫學中心或區域醫院多設有呼吸照護中心進行呼吸器之脫離，時問多在42天之內。當連續使用呼吸器超過63天仍無法脫離時，則多轉至地區醫院、呼吸照護病房照護。物理治療師可以與胸腔專科醫師合作，在個案於呼吸照護中心時即做早期氣道清潔維護以協助預防呼吸器相關的肺炎、訓練呼吸肌和身體功能所需的非呼吸肌肉，以協助個案早日脫離呼吸器和維持身體功能，並參與長期照護計劃和居家服務以增進個案之生活獨立性和生活品質。本文簡單介紹在四個不同階段國內外的一些研究文獻的結果，支持物理治療療效的證據仍有所欠缺，需要更多大型隨機控制的研究來探討物理治療在不同階段的介入、策略、成效和效益。要從事這方面的物理治療師還需要多一些的知識和技能，需對基本設備有所瞭解，在呼吸器限制下協助個案增加自我照顧的能力和減輕照護者的負擔。當走入居家照護，必要時要會排除基本設備障礙，瞭解相關的醫療資源和社會福利管道。

關鍵字

長期使用呼吸器 ； 物理治療

並列摘要

Integrated delivery system for patients with prolonged mechanical ventilation can be divided into four stages, stage of intensive care unit (ICU), respiratory care center (RCC), respiratory care ward (RCW), and home care respectively. Patients usually underwent aggressive weaning in RCC that locate mostly in medical centers and regional hospitals, while those who require mechanical ventilation more than 63 days are transferred to local hospitals or RCW. In the early stage, physical therapist can use airway clearance techniques to prevent ventilator associated pneumonia and include respiratory muscle training to assist weaning. Patients are also in need of physical therapy, especially in the stages of RCW and home care, to promote the independence in activities and improve quality of life. This article briefly reviewed the studies that investigated the effects of physical therapy in the four stages for patients with long-term mechanical ventilation. More randomized controlled trials are needed to study the intervention, strategies, benefits, and cost-effectiveness of physical therapy for these patients. Physical therapists should be prepared to equip the basic knowledge and skills of managing the equipments of use, such as ventilator and chest care equipments related to suctioning, aerosol and oxygen therapy, and percussion. In the stages of RCW and home care, physical therapy aims to improve patients' self independence and quality of life and reduce their caregivers' burden and stress. To be able to achieve the goals, physical therapists should also be familiar with the related medical resources and social benefits system.

並列關鍵字

Prolonged mechanical ventilation ； Physical therapy