胸腔復原運動於主動脈剝離術後合併急性呼吸窘迫症候群患者之療效

Pulmonary Rehabilitation in a Patient with Aortic Dissection Receiving Surgery and Acute Respiratory Distress Syndrome

蘇秋慧(Chiou-Hui Su) ； 徐玉凌(Yu-Ling Hsu) ； 蕭鐘慧(Chung-Hui Hsiao) ； 陳心怡(Hsin-Yi Chen) ； 曲文華(Wen-Hua Chu) ； 藍冑進(Chou-Chin Lan)

《呼吸治療》 11卷1期 (2012/01) Pp. 25-35

https://doi.org/10.6269/JRT.2012.11.1.03

摘要

目前胸腔復原運動已建議作為慢性阻塞性肺病（chronic obstructive pulmonary disease, COPD ）應有的治療之一，對於合併活動喘、生活品質不佳的患者，應建議給予運動訓練的輔助治療，然而對於一些COPD以外的疾病，目前胸腔復原運動的介入仍有限。本案例是一位A型主動脈剝離患者，接受手術治療，術後併發肺炎與急性呼吸窘迫症候群，因呼吸衰竭使用呼吸器，甚至需要使用體外循環膜式換氧系統。經過一連串積極治療，病患雖病情獲得控制，但卻因活動力明顯下降，生活無法自理，一度被送往安養院照護。經過我們十二週的胸腔復原運動，不但讓病患運動耐力上升，活動喘的情況改善，自主活動力增加，生活品質明顯改善，甚至讓病患有信心重返工作。然而，目前國內外對於主動脈剝離術後患者的運動訓練經驗仍有限，常使臨床醫師因疾病嚴重度，反而擔心運動之危險性而未給予訓練，我們希望藉由本案例的成功經驗，提供大家對此類患者更好的復原治療。（呼吸治療2012；11 （1）25-35）

關鍵字

胸腔復原運動 ； 主動脈剝離 ； 急性呼吸窘迫症候群

並列摘要

Pulmonary rehabilitation programs have been recommended as an integral part of management for chronic obstructive pulmonary disease (COPD) patients. Exercise training is regarded as an adjunct therapy for these patients, especially those associated with dyspnea and poor health-related quality of life. However, the effect of Exercise training in other diseases, such as aortic dissection is not clear. This is a case of a type A aortic dissection receiving surgery. After surgery, postoperative complications of pneumonia, acute respiratory distress syndrome and respiratory failure were happened. Mechanical ventilator and extracorporeal membrane oxygenation were ever used. After a series of aggressive treatment, the patient was under control with stable medical condition. However, due to prominently decreased activity and inability of self-care, he was sent to nursing home. After our 12-week exercise training, there was much improvement of exercise tolerance, decreased exertional dyspnea, increased daily activity and health-related quality of life. The patient had confidence to return to work. Experience of exercise training in patients with aortic dissection is still limited. Clinicians may hesitate to recommend exercise training for their severe illness. According to our case, exercise training is beneficial to patients with aortic dissection. We provide the successful experience of this case and hope to improve the management in such kind of patients.

並列關鍵字

Pulmonary rehabilitation ； aortic dissection ； acute respiratory distress syndrome