- 學位論文
慢性阻塞性肺病住院老人之心肺耐力相關影響因素探討
Factors Related to Cardiopulmonary Endurance of Hospitalized Olde Adults with Chronic Obstructive Pulmonary Disease
摘要
研究背景：慢性阻塞性肺病是一種長期呼吸道氣流阻塞慢性肺部疾病，平時容易有呼吸困難、慢性咳嗽、痰液多等症狀，容易引發肺部炎症反應，嚴重時甚至需要住院治療。隨著罹病時間增加，其肺功能逐漸衰退、呼吸困難程度增加、骨骼肌無力、營養不良及運動耐力下降，漸漸影響人際關係、生活品質，甚至產生心理健康問題，對家屬而言造成莫大負擔。而現今多數研究多關注於藥物治療、肺部復健、肌力訓練及自我管理實證研究改善慢性阻塞性肺病症狀和運動耐受力，但是對於影響心肺耐力衰退因素及預測因子鮮少有相關研究探討。 研究目的:探討慢性阻塞性肺病住院老人年齡、性別、疾病嚴重度、身體質量指數、呼吸困難、呼吸肌力、下肢肌力、下肢肌耐力與心肺耐力之相關性，並探討其預測因子、解釋力及模式。 研究方法:本研究設計為橫斷式、相關性研究，採隨機取樣。研究對象總共83位，均來自南部某一胸腔專科醫院且經醫師診斷為慢性阻塞性肺病住院老人，分別收集年齡、性別、疾病嚴重度、身體質量指數、呼吸困難程度、呼吸肌力、下肢肌力、下肢肌耐力與心肺耐力等資料。其中疾病嚴重度是依據慢性阻塞性肺疾病全球倡議指南分類，身體質量指數是測量BMI，呼吸困難程度以結構式問卷呼吸困難量表（mMRC）測量，呼吸肌力以呼吸肌壓力測量儀測量吸氣肌肌力和吐氣肌肌力，下肢肌力以手持式肌力測量儀測量股四頭肌肌力，下肢肌耐力則是測量30秒坐椅站立次數，最後是心肺耐力透過六分鐘行走距離(6MWD)測量。資料分析以獨立樣本t、單因子變異數、皮爾森相關及複迴歸分析變項之間與心肺耐力關係和預測因子。本研究已經通倫理委員會核准，同時於研究進行取得同意書才開始進行 研究結果:共83位參與研究。平均年齡為74.01 ±6.93歲、男性居多(90.63%)、身體質量指數異常＞60.25%、呼吸困難程度以第3級居多(57.83%)。在相關性分析：年齡(r =-0.27，p = 013)、吸氣肌力( r =0.54 ，p ＜.001)、呼氣肌力( r = 0.49，p＜.001)、下肢肌力(r = 0.34，p = 002)及下肢肌耐力(r = 0.64，p＜.001)與心肺耐力達顯著相關。在差異性分析：疾病嚴重度(F =10.28，p＜.001)、呼吸困難程度(F =11.16，p＜.001)與心肺耐力達顯著差異，但是與性別、身體質量指數未達顯著(all, p＞.05)。於複迴歸分析：疾病嚴重度之極重程度(參照組輕度)(β = -42.12，p ＝.011)，呼吸困難程度之第2級(參照組第4級)(β =58.16，p ＝.001)及下肢肌耐力(β = 17.35，p ＜.001)為心肺耐力之主要預測因子，解釋變異量53%(Adj R 2=0.53， p ＜.001)。 結論與建議:本研究結果，可以作為臨床工作 者了解COPD住院老人年齡、疾病嚴重度、呼吸困難程度(dypnesa)、下肢肌耐力與心肺耐力具相關性，透過研究改善慢性阻塞性肺病老人心肺耐力之負向危險因子、提升正向促進因子，建立一個有效益心肺耐力照護模式，進而提升COPD住院老人住院品質。
並列摘要
Background: Chronic Obstructive Pulmonary Disease (COPD) is characteristic with chronic airway inflammation and airflow obstruction, which presents as dyspnea and, chronic cough with sputum. Severe COPD with acute exacerbation needs hospitalization. Progressive and irreversible airway obstruction of COPD may result in dyspnea aggravation, malnutrition, sarcopenia, and decreased exercise capacity. Patients with COPD have not only impaired social activities but quality of life as well. The impact on family and carers for taking caregivers of COPD is substantial. Studies have shown that medical treatment, pulmonary rehabilitation, muscle training, and self-management can improve COPD symptoms and exercise capacity. However, studies investigating causes and predictor factors of cardiopulmonary endurance for COPD patients are scant. Purpose: To explore whether and how cardiopulmonary endurance is related to age, body composition, dyspnea, respiratory muscle strength, lower limb muscle strength and endurance. In addition, we evaluated predictor factors, explanatory power and models in a sample of the elderly hospitalized with COPD. Methods: This is a cross-sectional study design by using a random sampling in the elderly hospitalized with COPD. A total of 83 participants admitted to a chest specialist hospital with a diagnosis of COPD were enrolled in this study. We evaluated 6-minute walk distance (6MWD) for cardiopulmonary endurance, while age, sex, COPD severity, body composition, dyspnea, respiratory muscle strength, lower limb muscle strength and enduranceparameters were collected as well. We measured COPD severity by Global Initiative for Chronic Obstructive Lung Disease guideline (GOLD), body composition by body mass index (BMI), dyspnea by modified Medical Research Council dyspnea scale (mMRC), respiratory muscle strength by measuring the maximal inspiratory pressure (PImax) and the maximal expiratory pressure (PEmax), lower limb muscle strength by measuring quadriceps, and lower limb muscle endurance by measuringthe 30-s chair stand test. T test, one-way ANOVA, correlation, and multivariate regression analyses were used to evaluate association between variables and predictor factors. The study received approval from the Ethics Committee and informed consent was obtained from all study participants. Results: A total of 83 participants participated in the study. The study patients were aged 74.01±6.93years, were male (90.63%), body composition abnormalities > 60.25%, with stage 3 mMRC (57.83%). The Cardiopulmonary endurance was significantly associated with age (r =-0.27, p = .013), respiratory muscle strength including PImax ( r = 0.54 , p ＜.001) and PEmax(r = 0.49， p ＜.001), lower limb muscle strength (r = 0.34，p = .002), lower limb muscle endurance (r = 0.64, p ＜.001), COPD severity (F =10.28, p ＜.001), and dypnesa (F =11.16, p＜.001). Mulitvariate analyses showed that cardiopulmonary endurance was associated with the severity of disease (extremely severe reference group mild) (β = ﹣42.12, p ＝.011), dypnesa (level 2 reference group level 4) (β =58.16, p ＝.001) and with lower limb muscle endurance (β = 17.35, p ＜.001). These variables can explain 53% (Adj R 2=0.53， p ＜.001) of variance in the cardiopulmonary endurance of older adults with COPD. COPD severity, dypnesa and lower limb muscle endurance were main predictive factors that explained 41% of variance (R2 = 0.41, p ＜.001). Conclusion: This study indicated that cardiopulmonary endurance was associated with age, respiratory muscle strength, lower limb muscle strength, lower limb muscle endurance, COPD severity and dypnesa. Our results may provide caregiver information to improve cardiopulmonary endurance in the elderly with COPD.