間歇性使用非侵襲性正壓呼吸器：一個案報告

Intermittent Non-Invasive Positive Pressure Ventilater Support-A Case Report

黎瑞萍(Jui-Ping Li) ； 陳乃釧(Nai-Chuan Chen) ； 洪宗杰(Tsung-Chieh Hung) ； 王寧道(Ning-Tao Wang)

《安寧療護雜誌》 13卷4期 (2008/11) Pp. 484-493

https://doi.org/10.6537/TJHPC.2008.13(4).8

摘要

個案是一位66歲有長期吸菸習慣的男性，罹患慢性阻塞性肺病，持續運動性氣促已至慢性呼吸衰竭程度，病情時常惡化造成就醫住院次數頻繁，肺功能和運動耐受性以及身體殘餘功能逐步下降，呼吸困難情形增加，自我照護能力差，身心俱疲，憂鬱絕望心情，期間曾多次告訴醫師想安樂死，不願意痛苦地延續生命，並且簽署『選擇安寧緩和醫療意願書』。個案在2005年呼吸困難症狀加劇，因而開始使用間歇性非侵襲性呼吸器(NIPPV/Bipap)的支持，其呼吸困難症狀減輕後再配合心肺復原運動，有效減輕個案呼吸困難及增進生活品質，並在疾病末期仍持續使用至臨終。經由照顧這位個案的經驗，我們建議在某些末期患者出現呼吸困難症狀時，除給氧、藥物輔助外，可以提供給病人除了插管以外的另一項有效的呼吸輔助方法，藉由提早訓練病人間歇性使用NIPPV，能幫助末期生活品質提升及症狀減輕和可能延長生存期限。

關鍵字

末期慢性阻塞性肺病 ； 非侵襲性呼吸器 ； 安寧

並列摘要

A 66 year-old heavy smoker who had persisted dyspnea on exertion. Frequent admissions were inevitable due to irreversible change of pulmonary function and physical condition. Poor quality of life, loss of ability of self-care, and worsening symptoms made him depressed. He told his doctor many times that he want to end his life. Cardio-pulmonary rehabilitation program and non-invasive positive pressure ventilator (NIPPV) were introduced which improved his quality of life and symptoms. He passed away two years later peacefully with smooth hospice care course finally.
Early training of using intermittent NIPPV support for terminal COPD hospice patient may do some help in quality of life, symptomatic relief, and possible survival time.

並列關鍵字

terminal chronic obstructive pulmonary disease ； non-invasive positive pressure ventilator NIPPV ； hospice