住院老人病患於腹部手術後接受早期漸進性活動 之成效探討

Effects of Early Mobilization in Postoperative Elderly Patients Undergoing an Elective Abdominal Surgery

吳麗娟(Li-Chuan Wu)

指導教授 ： 陳佳慧

國立臺灣大學/醫學院/護理學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.10102

摘要

住院中日常生活功能下降是一個常見的現象，臥床是造成肌肉力量下降、肺擴張不全及日常生活功能下降的重要因子，對腹部手術後的住院老人影響更甚。本研究目的探討早期活動介入於腹部術後的住院老人在日常生活功能及肌肉力量的改善成效。本研究為前、後測之臨床控制試驗(Controlled Clinical Trial, CCT)。於北部某醫學中心，選取符合年齡大於65歲、接受腹部手術且預期術後住院天數大於5天之個案數共108位，九十六年八月至九十七年四月，收為控制組共71人；九十七年五月至九十七年八月為實驗組共37人。控制組接受病房常規照護(usual care)，實驗組術後第一天開始接受早期活動介入措施直到出院。測量項目包括日常生活功能(巴氏量表)、肌肉力量(hand grip strength)。統計方法以配對t檢定(Paired t test)、獨立t 檢定(Independence t test)、共變數分析(ANCOVA)及多元迴歸分析(Multiple linear regression)檢定資料，研究結果以p＜0.05為顯著意義。研究顯示: (1) 日常生活功能方面，實驗組的巴氏量表下降平均差，顯著低於控制組(12.5 ± 10.5 vs 28.0 ± 10.5 ) (p < 0.001)，實驗組在術後三週已持續恢復，與出院時相比達顯著上升(91.9 ± 10.2 vs 86.6 ± 10.4) (p < 0.01)。(2) 肌肉力量，實驗組出院時握力顯著高於控制組(24.6 ± 7.8公斤vs 20.6 ± 8.2公斤) (p = 0.03)。(3) 實驗組術後住院天數平均短於控制組(13.2 ± 6.4 vs 17.6 ± 16.2天) (p < 0.05)。整體而言，早期漸進性活動對腹部術後住院老人可有效預防日常生活功能及肌肉力量的下降，建議未來可運用於臨床護理。

關鍵字

早期活動 ； 日常生活功能 ； 腹部手術 ； 肌肉力量 ； 巴氏量表

並列摘要

Functional decline is a common threat to elderly hospitalized patients. Immobility is one of the major contributors lead to decreased muscle strength, atelectasis, and functional decline. For elderly patients undergoing abdominal surgery, risks for these threats are even greater. The purpose of this study was to test the effect of an early mobilization protocol in postoperative elderly patients undergoing an elective abdominal surgery. A pre-and post controlled clinical trial design was employed with the subjects enrolled during 8/2007 to 4/2008 served as the control group (n=71) and subjects enrolled since 5/2008 served as the experimental group (n=37). In total, 108 subjects aged 65 years and older who scheduled for an elective abdominal surgery with expected postoperative length of stay over 5 days were enrolled from a 2000-bed medical center in Taipei, Taiwan. For the experimental group, a daily standardized 20-minute early mobilization protocol was conducted by a research nurse trained for the project until patient discharge. Subjects in the control group received usual care. The major outcome measures included hand grip strength, and activities of daily function measured by Barthel Index, A P value of less than 0.05 was considered significant.
The results showed that patients at experimental group had significant less decline in Barthel index during hospitalization (12.5 ± 10.5 vs. 28.0 ± 10.5 points, p < 0.001) and better hand grip strength at discharge (24.6 ± 7.8 kg vs. 20.6 ± 8.2 kg, p = 0.03), compared to the control group. In addition, the postoperative length of stay in the experimental group was significantly shorter than the control group (13.2 ± 6.4 vs. 17.6 ± 16.2 days, p < 0.05). This early mobilization intervention is shown to be feasible and effective in reducing functional decline for elderly patients who undergoing an elective abdominal surgery.

並列關鍵字

early mobilization ； activities of daily function ； elective abdominal surgery ； hand grip strength ； Barthel Index

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