提升呼吸器依賴病人肺部復健運動執行率之方案

Pulmonary Rehabilitation Program for Ventilator-Dependent Patients: A Report on Implementaion

洪淑芬(Shu-Fen Hung) ； 葉惠慈(Te-Hsin Chang) ； 楊黛芬(Dai-Fang Yang) ； 李佳佳(Li-Hsueh Chen) ； 古雪貞(Hsueh-Chen Ku)

《馬偕護理雜誌》 10卷1期 (2016/01) Pp. 33-46

https://doi.org/10.29415/JMKN.201601_10(1).0003

摘要

長期呼吸器依賴病人會增加醫療耗用，台灣平均每位每年呼吸器依賴病人所耗用之醫療費用約230萬元，單位脫離率38.1%，而呼吸肌肉疲乏是造成無法脫離呼吸器的重要原因。本單位為某醫學中心呼吸照護中心，針對因呼吸肌肉疲乏導致呼吸器依賴之病人，提供適當的肺部復健運動及措施，協助病人成功脫離呼吸器。經由制定「肺部復健運動規範」、使用「手套式環保舉重瓶」、增加肺部復健運動設備、規劃方便取用肺部復健運動設備、新增肺部復健護理指導輔助工具、舉辦肺部復健運動在職教育、新增肺部復健運動於新進人員學習護照、新增病人肺部復健運動集點卡及獎狀、肺部復健運動列入交班、實施肺部復健運動持續品質審查。肺部復健運動執行率由32.4%提升為91.3%，呼吸器脫離率由38.1%提升為58.4 %。本專案加強呼吸器依賴病人之呼吸肌肉強度和耐力訓練，能有效的提升呼吸器脫離率，反映出肺部復健運動對呼吸器脫離的重要性，未來讓更多呼吸器依賴的病人能夠早日脫離呼吸器，減少醫療耗用，提升病人和家屬的生活品質。

關鍵字

肺部復健運動 ； 呼吸器脫離率 ； 呼吸照護中心

並列摘要

Care of long-term ventilator-dependent patients result in high medical cost. In Taiwan, the average annual cost for ventilator-dependent patients is about 2.3 millions New Taiwan dollars, with 38.1% of successful ventilator weaning rate. The key factor leading to patients' inability to wean ventilators is the respiratory muscles fatigue. The studied site is a respiratory care unit of a medical center providing care for ventilator-dependent patients with respiratory muscle fatigue and offering a series of pulmonary rehabilitation exercises to assist the patients weaning ventilators. This unit project undertookseveral tasks including (1) formulating the ＂Pulmonary Rehabilitation Exercise Norms,＂ (2) ＂eco-friendly weightlifting glove bottles,＂ (3) adding pulmonary rehabilitation sports equipment, (4) easy access to pulmonary rehabilitation exercise equipment, (5) adding new pulmonary rehabilitation care guidance tools, (6) providing in-service educational courses on pulmonary rehabilitation exercises, (7) producing a learning passport of pulmonary rehabilitation exercises for new staff, (8) adding pulmonary rehabilitation exercise point cards and awards for patients, and (9) including the patients' ＂Pulmonary Rehabilitation Exercise Program＂ details in the handover during shift changes, and (10) implementing audit review of continuous quality on pulmonary rehabilitation exercise program. Not only the execution rate of pulmonary rehabilitation exercise increased from 32.4% to 91.3%, ventilator weaning rate also increased from 38.1% to 58.4%. The project emphasized on strengthening the respiratory muscle strength and provided endurance trainings for ventilator-dependent patients, which have improved the ventilator weaning rate in the unit. The outcome indicates the importance of pulmonary rehabilitation exercise program for weaning the ventilators, which is effective in assisting the ventilator-dependent patients weaning their ventilator earlier, and last but not the least, to reduce the associated medical cost and enhance quality of life for the patients and their families.

並列關鍵字

pulmonary rehabilitation exercise ； ventilator weaning rate ； respiratory care center