肺部復健運動對居家高齡慢性阻塞性肺病使用非侵襲性呼吸器依賴患者之成效

摘要研究背景: 肺部復健運動有助於高齡慢性阻塞性肺病患者緩和症狀與維持穩定生活功能，但肺部復健運動多在醫院於專業人員的監督下執行，無法真正落實於居家日常保健。研究目的: 探討肺部復健運動對居家高齡慢性阻塞性肺病使用非侵襲性呼吸器依賴患者之吸氣肌力、運動能力、呼吸器脫離時數、肺功能維持、呼吸困難程度及健康相關生活品質之成效。研究方法: 採隨機控制臨床實驗研究設計，收案對象為居家高齡慢性阻塞性肺病使用非侵襲性呼吸器依賴患者，隨機分為控制組 (N=14) 及實驗組 (N=14)。控制組接受居家常規衛教，實驗組除居家常規衛教外，另加上為期八週之肺部復健運動訓練。於前測、第八週、第十二週以肺量計、壓力表、聖喬治呼吸問卷、兩分鐘抬膝測試、改良伯格氏量表等工具測量進行評估，以雙因子重複變異數分析檢驗訓練成效。研究結果: 執行肺部復健運動後，吸氣肌力方面，實驗組在第八週及第十二週皆有顯著增加 (p<0.05)，控制組第十二週呈現顯著退步；運動能力方面，實驗組在第八週及第十二週皆有顯著進步 (p<0.05)，控制組則無顯著改變；呼吸器使用時數方面，實驗組於第八週測量平均每天比控制組減少2.9小時之呼吸器依賴時數，第十二週測量平均每天比控制組減少3.97小時之呼吸器依賴時數，皆達顯著差異 (p=0.000)；肺功能參數方面，實驗組之用力肺活量 (FVC) 、用力呼氣一秒量 (FEV1) 於第八週及第十二週皆達顯著改善 (p＜0.05)，用力呼氣一秒率 (FEV1/FVC) 未達顯著差異，控制組則顯著變差；呼吸困難程度方面，實驗組在第八週及第十二週皆有顯著下降 (p<0.05)，控制組則顯著上升；生活品質方面，實驗組在聖喬治呼吸量表之症狀、活動、衝擊及整體總分皆達顯著改善 (p<0.05)，控制組皆顯著變差。研究結論: 肺部復健運動有助於增加吸氣肌力、運動能力、維持肺功能、減少呼吸器依賴時數、緩解呼吸困難並改善生活品質，本研究之肺部復健運動計畫可作為醫護人員照護之參考，以提供居家高齡慢性阻塞性肺病使用非侵襲性呼吸器依賴患者作為常規訓練。

關鍵字

肺部復健運動；慢性阻塞性肺病；居家照護；非侵襲性呼吸器

並列摘要

Abstract Background: Pulmonary rehabilitation has become a standard of care to control symptoms and maintain a stable function for performing daily ac-tivities in patients with chronic obstructive pulmonary disease (COPD).The pulmonary rehabilitation exercise is usually provided in hospitals under the supervision of health professionals. However, hospital-based rehabil-itation is not practical for daily training. Purpose: To investigate the effect of home-based pulmonary rehabilitation exercise on inspiratory muscular strength, exercise capacity, pulmonary function maintenance, ventilator weaning duration, dyspnea, and health-related quality of life for the non-invasive ventilator dependent elderly with COPD. Methods: A randomized controlled trial design was conducted. Twen-ty-eight COPD ventilator-dependent patients were randomly divided into the experimental group (n = 14) and the control group (n = 14). The control group received general education, while the experimental group received 8-week pulmonary rehabilitation exercise additionally. Measurements were taken by spirometry, pressure gauge, 2-min step test, St. George respira-tory questionnaire, modified Borg scale at baseline, 8th, and 12th week to evaluate the treatment effect. Result: The inspiratory strength was significantly increased at 8th and 12th weeks for the experimental group, while the control group was decreased at 12th week. The exercise capacity was significantly improved for the ex-perimental group at 8th and 12th weeks (p <0.05), while the control group was not significantly changed. For the ventilator usage per day, the ex-perimental group was significantly improved at 8th and 12th weeks in that 2.9 hours and 3.97 hours less than the control group at 8th and 12th weeks (p = 0.000), respectively.The forced vital capacity (FVC)、forced expiratory volume in 1 second (FEV1) were significantly improved at 8th and 12th weeks (p＜0.05) for the experimental group, while the control group was significantly decreased. The FEV1/FVC was non-significant for both groups. The dyspnea by modified Borg scale was significantly improved at 8th and 12th weeks for the experimental group, while the control group was deteriorated at 12th week. All subscales and the total score of the St. George respiratory questionnaire were significantly improved for the experimental group at 8th and 12th weeks (p <0.05), while the control group was deteri-orated. Conclusion: Pulmonary rehabilitation exercise can help increase inspira-tory muscle strength and exercise capacity, reduce ventilator dependent hours, maintain lung function, alleviate dyspnea and improve quality of life. Home- based pulmonary rehabilitation exercise can be used as a routine training for non-invasive ventilator depedent elderly with chronic obstruc-tive pulmonary disease.