運用吸氣肌訓練器改善重症插管病患之呼吸器脫離指標

The effect of inspiratory muscle trainer (IMT) on the weaning profile of intubation patients in ICU

宋雅雯(Ya-Wen Sung)

指導教授 ： 陳幼梅

高雄醫學大學/護理學院/護理學系研究所/碩士(2011年)

摘要

本研究旨在探討運用吸氣肌訓練器介入後，改善重症插管病患呼吸器脫離指標之成效。本研究採雙組前後測之類實驗設計，以立意取樣、方便分配在南部某教學醫院二個成人內科加護病房進行，共收100位重症插管個案，分別為介入組48位、控制組52位，自符合脫離呼吸器條件到拔管為止，控制組僅接受一般臨床之脫離呼吸器訓練（每天2小時的高流量氧氣訓練：Venturi），而介入組則以每天個案之30% Pimax為訓練強度，接受20分鐘之閾值壓力式吸氣肌訓練器訓練及一般臨床之脫離呼吸器訓練（每天2小時的高流量氧氣訓練：Venturi），二組每天均監測其最大吸氣壓（Pimax）、快淺呼吸指標（RSBI）之前、後測。研究資料以SPSS14.0中文版套裝軟體進行分析，以描述性統計、卡方檢定、費雪精確性檢定、獨立t檢定、配對t檢定進行統計檢定。
研究結果發現吸氣肌訓練器介入後，介入組個案的最大吸氣壓（Pimax）不但有改善，且會隨著訓練計畫的進行而持續保有顯著差異(p<.05)，而無接受吸氣肌訓練器之控制組重症插管個案，其最大吸氣壓（Pimax）要到結案日後測上才可達顯著差異(p<.05)，雖然介入組在快淺呼吸指標（RSBI）的改善、呼吸器成功脫離率上均優於控制組，但卻無法有顯著差異(p>.05)。介入組成功脫離呼吸器者訓練計畫耗費的天數、失敗重插管率雖然比控制組少，但未達統計學上的顯著差異(p>.05)。
本研究乃針對國內重症插管個案進行呼吸肌復健訓練的前驅研究，吸氣肌訓練器在本研究成果顯示對於增強肌肉力量，特別是最大吸氣壓有顯著的改善，最大吸氣壓對於呼吸肌疲乏和脫離呼吸器具有重要的影響，建議未來對於重症插管個案加強呼吸肌復健訓練時可以採用此方法。

關鍵字

吸氣肌訓練器 ； 重症插管 ； 最大吸氣壓 ； 快淺呼吸指標 ； 呼吸器成功脫離率

並列摘要

The purpose of this study is to investigate the effect of the inspiratory muscle trainer (IMT) on the weaning profile of intubated patients in ICU. The study adopted a quasi-experimental design. Two intensive care units in a medical center in southern Taiwan are set respectively as the experimental and control units. The patients, who were assigned in the control unit (n=52), received the general weaning training (i.e., the T-piece trial for 2 hours daily). The patients, who were assigned to the experimental unit (n=48), were provided with the intervention of IMT, in addition to the general weaning training. The IMT was set to the level of 30% Pimax of the patient and was applied for 20 minutes daily until extubation or the respiratory function was deteriorating. The levels of Pimax and RSBI before and after the intervention were collected. The data were analyzed by using SPSS 14.0.
The results revealed that, compared to the control group, IMT improved Pimax continuously across the training period in the intervention group (p <.05). On the contrary, the Pimax in the control group only improved significantly until the day of extubation (p <.05). Although not statistically significant, the RSBI and the weaning rate of the experimental group were better than those of the control group. The time to successful weaning from ventilator and the re-intubation rate were better shorter in the intervention group than in the control group, although not statistically significant (p> .05).
This pilot study provides preliminary results of the effect of the inspiratory muscle trainer (IMT) for intubated patients in ICU. The respiratory muscle rehabilitation training is helpful for intubated patients in ICU, especially for the Pimax level. It is suggested that the clinicians may applied IMT as a standard rehabilitative care for intubated patients in ICU. Yet the effect of IMT to successful weaning requires further research to determine.

並列關鍵字

inspiratory muscle trainer (IMT) ； intubation patients in ICU ； maximal inespirtory mouth pressure (Pimax) ； rapid shallow breathing index(RSBI) ； successful ventilator weaning rate.

參考文獻

中文參考文獻

丁予安（2003）•重症醫學精要•台北：藝軒。

王桂芸（1995）•呼吸機脫離失敗之相關因素及其因應措施•護理雜誌，42(2)，20 -27。

王慈蕙（2002）•閾值壓力式吸氣肌訓練儀對依賴呼吸器患者的成效•未發表的碩士論文，台北：台灣大學物理治療學研究所。

王桂芸（2007）•呼吸系統疾病之護理•於劉雪娥總校閱，成人內外科護理（四版，843-1035頁）•台北：華杏。