正壓吐氣輔助器於慢性阻塞型肺疾病之效用

背景：慢性阻塞性肺疾病(COPD)是一個可預防也可治療的常見疾病，其特徵為吐氣氣流受阻及漸進之氣道及全身發炎反應，穩定型COPD之傳統治療方式包括肺部復健、噘嘴呼吸及藥物治療，然而其舒緩喘的感覺之成效仍有其限制。本研究目的為確認正壓吐氣輔助器(PEP)和/或震盪正壓吐氣輔助器(OPEP)相對於肺部復健是否有較佳之生活品質、喘的程度及運動耐受性。研究方法：本研究為前瞻性隨機控制試驗。24位COPD患者接受八週肺部復健後隨機分佈至八週肺部復健(控制組)；八週持續進行肺部復健，另於每日至少20分鐘行走訓練間使用PEP舒緩喘的感覺(PEP組)；八週持續進行肺部復健及行走訓練使用PEP，另每日至少15分鐘使用OPEP進行清痰。於基準值、八週及十六週進行修改後英國醫學研究會問卷(mMRC)、慢性阻塞性肺疾病評估量表(CAT)、聖喬治呼吸量表(SGRQ)、六分鐘走路測試(6MWT)及順應性等評估。結果：各組十六週後SGRQ、CAT及6MWD組間均無差異，然組內比較之PEP組接受治療後其SGRQ-症狀 (46.6±17.1 v.s. 19.8±16.4, p=0.011),及衝擊(34.1±24.2 v.s. 21.0±14.8, p=0.055) 相對於接受八週肺部復健後有統計上顯著差異；組內比較之OPEP組接受治療後其SGRQ-症狀(41.2±17.3 v.s. 28.7±13.9, p=0.027), 及整體分數(36.3±18.1 v.s. 30.3±18.5, p=0.036)相對於接受八週肺部復健後有統計上顯著差異。結論：相較於肺部復健， PEP及OPEP使用於穩定型COPD病患未有顯著效果，然而仍可進一步研究探討PEP生理效用之長期應用，並探討其使用於較高嚴重程度之COPD患者之成效。

關鍵字

慢性阻塞性肺疾病；正壓吐氣輔助器；震盪正壓吐氣輔助器；生活品質

並列摘要

Introduction: Chronic Obstructive Pulmonary Disease (COPD), is a preventive and reversible disease, characterized by airflow limitation and progressive airway and systemic inflammation. Treatment on stable COPD includes pulmonary rehabilitation, purse-lip breathing, and pharmacologic therapy, but there are limitations on performance of dyspnea reduction. The study is aimed to determine the efficacy of application of Positive Expiratory Pressure (PEP) and Oscillating Positive Expiratory Pressure (OPEP) on Quality of Life (QoL), degree of dyspnea and exercise tolerance compare with pulmonary rehabilitation. Methods: This is a prospective, randomized control trial study. Twenty-four COPD patients were recruited and devided into three groups after received eight-week pulmonary rehabilitation(PR) . Control group continued PR for the following 8 weeks; Participants in PEP group use PEP if dyspnea in a daily 20-min walking for following 8 weeks; Subjects in OPEP receive the same PEP therapy and received OPEP therapy in daily bronchial hygiene f for following 8 weeks. The modified Medical Respiration Council (mMRC), COPD assessment test (CAT), StGeorge’s Respiratory Questionnaire (SGRQ) and Six-Minute Walking Test(6MWT) were measured at baseline, 8 weeks and 16weeks. Home diary was record to monitor compliance. Results: There were no signiﬁcant difference between-group during study period for SGRQ, CAT and pre-6MWT borg scale, but SGRQ-symptom(46.6±17.1 v.s. 19.8±16.4, p=0.011), and impact(34.1±24.2 v.s. 21.0±14.8, p=0.055) related to PR were statistically significant difference among PEP group, and SGRQ-symptom(41.2±17.3 v.s. 28.7±13.9, p=0.027), and total score(36.3±18.1 v.s. 30.3±18.5, p=0.036) related to PR were statistically significant difference among OPEP group. Differences in mean PR to OPEP treatment changes in SGRQ-symptom is statistically significant difference between usual sputum producer or not in OPEP group. Conclusions: We found no enough evidence to prove the efficacy of PEP and OPEP therapy in stable COPD related to pulmonary rehabilitation. Further studies will be applied to investigate PEP devices performance and may extrapolate to COPD patient with significant symptoms.

並列關鍵字

COPD ； PEP ； OPEP ； Pulmonary rehabilitation ； Quality of Life

參考文獻

吳蕙屏,范國聖,蔡宗益.臺灣慢性阻塞性肺疾病患者憂鬱症發生率之世代追蹤研究.志為護理11卷6期

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正壓吐氣輔助器於慢性阻塞型肺疾病之效用

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