食道癌患者接受同步併用化學放射線治療對呼吸功能之影響及吸氣肌訓練介入之成效探討

The effects of concurrent chemoradiation therapy on respiratory function and the efficacy of inspiratory muscle training in patients with esophageal cancer

黃怡璇(Yi-Hsuan Huang)

指導教授 ： 王儷穎

國立臺灣大學/醫學院/物理治療學研究所/碩士(2016年)

https://doi.org/10.6342/NTU201602303

摘要

背景：臺灣食道癌的發病率持續居高不下。同步併用化學放射線治療為最常見的食道癌治療策略，治療對呼吸功能、身體活動功能和生活品質的的影響及吸氣肌訓練的可能性，都是需要進一步探討的課題。目的：本研究之主要目的（一）追蹤評估新診斷原發性食道癌患者進行同步併用化學放射線治療對呼吸功能、身體活動功能和生活品質之影響；及（二）探討治療期間同步進行吸氣肌訓練，對呼吸功能、身體活動功能及生活品質之效益。方法：本研究第一階段共徵招33位受試者，在治療前後，收集受試者之臨床表徵資料並進行呼吸功能（最大呼吸壓測試及肺功能測試）、身體活動功能及生活品質問卷評估。第二階段共徵招6位受試者（對照組及吸氣肌訓練組各3人）。所有測試分別在治療開始前、治療期間每週至治療結束，臨床資料收集及測量項目同第一階段。橫膈肌表面肌電圖評估在最大吸氣壓測試及執行吸氣負荷任務時合併進行。吸氣肌訓練劑量為基線最大吸氣壓之30%（15次/回、3回/天、7天/週），持續至治療結束。以廣義估計方程式（Generalized Estimating Equations, GEE）、線性廣義方程式（Generalized Linear Model, GLM）檢定不同測試時間點在組間及組內之差異，顯著水平標準訂為0.05。結果：第一階段：相較於治療前，受試者之最大吸氣壓、第1秒用力吐氣容積與用力吐氣肺活量皆有顯著下降（p<0.01）；身體活動功能及整體生活品質、身體功能、角色功能和疲勞程度也在治療結束後有顯著下降（p<0.01）。第二階段：接受吸氣肌訓練者，其最大吸氣壓、身體活動功能及部分生活品質面向在治療期間均有明顯改善。橫膈肌肌電評估結果顯示訓練後其活化度效率及抗疲勞能力較佳。結論：食道癌患者接受同步併用化學放射線治療會造成呼吸功能、身體活動功能與生活品質下降。與治療同步之吸氣肌訓練具可改善食道癌患者在治療後之呼吸功能（如：橫膈肌肌電活化度及抗疲勞能力）、身體活動功能及生活品質之臨床效益。

關鍵字

食道癌 ； 呼吸功能 ； 橫膈肌表面肌電圖 ； 吸氣肌訓練

並列摘要

Background: Incidence rate of esophageal cancer remains high in Taiwan. The impacts of concurrent chemoradiation therapy (CCRT) on respiratory function, physical activity, and quality of life, and the efficacy of inspiratory muscle training (IMT) remains to be determined in patients with esophageal cancer. Purposes: The purposes of this study were to 1) evaluate the effects of CCRT and 2) investigate the effects of synchronous IMT during CCRT on respiratory function, physical activity, and quality of life in patients with newly diagnosed esophageal cancer. Methods: Phase I: a total of 33 subjects were recruited. Clinical data were collected and respiratory function (maximal respiratory pressure and pulmonary function test), physical activity, and quality of life were assessed at baseline and after CCRT was completed. Phase II: a total of 6 subjects were recruited and assigned to either control or IMT group (n=3 per group). Clinical data collection and all measurements were identical to phase I at baseline, and once per week until CCRT was completed. Diaphragmatic surface electromyography was used to exam diaphragm activity during performing maximal inspiratory pressure (MIP) and IMT tasks. Patients in IMT group received IMT with an intensity of 30%MIP, 15 times/set, 3 sets/day for 7 days/week, until CCRT was completed. Generalized Estimating Equations and Generalized Linear Model were used to detect differences of variables between and within groups. Significant level was set at 0.05. Results: Phase I: compared to baseline, respiratory function, physical activity, and quality of life all decreased after CCRT in patients with esophageal cancer (all p<0.01). Phase II: MIP, physical activity and certain aspects of quality of life showed improvement after CCRT in the IMT group. Electromyography showed that diaphragm activation efficiency and fatigability improved after training in the IMT group. Conclusions: CCRT has negative impacts on respiratory function, physical activity, and quality of life in esophageal cancer patients. Synchronous IMT during CCRT showed promising potential to improve respiratory function (e.g., diaphragm function), physical activity, and quality of life in patients with esophageal cancer.

並列關鍵字

Esophageal cancer ； Respiratory function ； Diaphragmatic surface electromyography ； Inspiratory muscle training

參考文獻

15. 楊佩瑜。以動物模式探討阻力呼吸訓練對降低放射照射引起之橫膈肌收縮功能異常之成效。臺灣大學物理治療學系暨研究所。碩士論文；2014。

102. 許玉娟。營養諮商與運動方案對接受放射治療合併化學治療之食道癌病患改善成效之探討。臺灣大學護理學研究所。碩士論文；2013。

1. 行政院衛生福利部國民健康署。民國103年主要死因統計結果分析。臺灣；2015。

2. Shridhar R, Imani-Shikhabadi R, Davis B, Streeter O, Thomas C, Jr. Curative treatment of esophageal cancer: an evidenced based review. J Gastrointest Cancer 2013;44:375-84.

3. Stahl M, Mariette C, Haustermans K, Cervantes A, Arnold D. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24 Suppl 6:51-6.