自我調節方案對改善慢性阻塞性肺疾病病人急性加重症狀之成效

Improving Acute Exacerbation Symptoms in COPD Patients: Effectiveness of the Self-Regulation Protocol

郭嘉琪(Chia-Chi Kuo) ； 林秋菊(Chiu-Chu Lin)

《護理暨健康照護研究》 5卷3期 (2009/09) Pp. 182-192

https://doi.org/10.6225/JNHR.5.3.182

摘要

背景　慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease, COPD)病人普遍有急性加重的困擾。
目的　本研究旨在探討「自我調節方案」對改善COPD病人急性加重症狀之成效。
方法　研究採前測及二次後測之雙組實驗設計；方便取樣南部某醫學中心胸腔內科門診之COPD病人，以抽籤隨機分派至實驗組33人與對照組31人，實驗組個案接受為期四週的「自我調節方案」介入，包括：一次15-20分鐘的自我調節個別衛教，及5-7次，每次15-20分鐘的電話追蹤；而對照組除提供自我調節手冊之外，未接受任何介入措施。本研究採用呼吸困難、症狀困擾量表及尖峰呼氣流量計來評量介入措施前後測差異。
結果　研究結果發現「自我調節方案」介入後，實驗組在呼吸困難程度與症狀困擾程度均呈顯著下降、尖峰呼氣流量無顯著變化；對照組在呼吸困難及症狀困擾程度則無明顯改變、尖峰呼氣流量呈顯著變差。兩組於介入措施後第九週在呼吸困難、症狀困擾程度的改善幅度均達顯著差異。
結論／實務應用　結果顯示「自我調節方案」可協助COPD個案判斷與控制其個別的加重因子，達到控制急性加重症狀之目標，據此實證結果，吾人建議將本研究所發展之以自我調節理論為根基的介入措施方案，推展於臨床實務與實證研究領域中。

關鍵字

慢性阻塞性肺病 ； 急性加重 ； 加重因子 ； 自我調節

並列摘要

Background: Patients with chronic obstructive pulmonary disease (COPD) frequently have acute exacerbation problems.
Purpose: The purpose of this study was to investigate the effectiveness of employing a self-regulation protocol to improve acute exacerbation symptoms in COPD patients.
Methods: This study employed a two-group experimental study design. Sixty-four patients with COPD currently undergoing treatment at a medical center of southern Taiwan were randomly divided into an experimental and comparison group of thirty-three and thirty-one patients, respectively. Both groups were assessed at three separate periods, including pre-test, post-test 1 (5(superscript th) week) and post-test 2 (9(superscript th) week). The experimental group received a four-week selfregulation protocol, which included: 15-20 minutes of one-to-one COPD education and 5-7 phone call follow ups (of 15-20 minutes each). The comparison group received a self-regulation manual only. Borg Dyspnea Scale, Symptom Distress Scale and peak expiratory flow meter were used in this study to measure differences between pre-and posttest values.
Results: After comparing pre-and post-test scores, we found a significant drop in Borg Dyspnea Scale and Symptom Distress Scale scores and insignificant change in peak expiratory flow for experimental group participants. Changes in comparison group scores in terms of the Borg Dyspnea Scale and Symptom Distress Scale were insignificant, but peak expiratory flow was significantly lower. On the 9(superscript th) week after intervention, we found a significant difference between the two groups in terms of Borg Dyspnea Scale, Symptom Distress Scale and peak expiratory flow meter values.
Conclusion/Implications for practice: Study results indicate that the self-regulation protocol developed here helps subjects differentiate and control their individual exacerbating factors, control their symptoms and avoid acute exacerbation. Thus, we recommend that this theory-based intervention be utilized in the clinical and research fields.

並列關鍵字

chronic obstructive pulmonary disease ； acute exacerbation ； exacerbation factors ； self-regulation