以兩種不同非侵入性氧氣治療對癌症末期病人呼吸困難緩解效果之比較

Comparison of the Effects of Relieving Dyspnea in Advanced Cancer Patients with Two Different Noninvasive Oxygen Therapy

廖偉真(Wei-Chen Liao) ； 黃惠美(Hui-Mei Huang) ； 黃齡慧(Ling-Hui Huang)

《榮總護理》 36卷3期 (2019/09) Pp. 255-265

https://doi.org/10.6142/VGHN.201909_36(3).0005

摘要

癌症末期病人呼吸困難的治療目標在於症狀緩解，常見非侵入性氧氣治療方式，可選擇雙相型陽壓呼吸器（BiPAP）多功能霧化器氧氣治療（all-purpose nebulizer），或兩者交替使用病人配戴的面罩則作為氧氣輸送的路徑。本研究目的在比較使用BiPAP與all-purpose nebulizer 改善癌症末期病人呼吸困難緩解效果。研究方法在中部某醫學中心，採觀察性研究設計，立意取樣共收案36人。結果發現病人使用BiPAP及all-purpose nebulizer前、後呼吸困難分數在統計上均呈顯著差異（Z_(BiPAP)= -4.50, p ＜ .001；Z_(all-purpose nebulizer)= -3.64, p＜ .001），且BiPAP改善呼吸困難程度較all-purpose nebulizer佳（Z = -2.65, p＜ .01）。以面罩造成的困擾症狀，使用BiPAP面罩的困擾症狀高於all-purposenebulizer面罩（20.61±6.21vs. 8.81±5.39分）。使用BiPAP或all-purpose nebulize皆能緩解病人呼吸困難症狀，以使用面罩產生的困擾症狀而言，BiPAP面罩影響程度相對嚴重。未來臨床醫護人員面對癌症末期呼吸困難病人選擇高流量氧氣治療時，可提供個別性護理，並減少困擾症狀的影響降至最低。

關鍵字

癌症末期 ； 呼吸困難 ； 雙相型陽壓呼吸器 ； 多功能霧化器氧氣面罩

並列摘要

Patients with lung cancer and terminal lung metastases are prone to dyspnea, with the main target of treatment being symptomatic relief. Many options for oxygen treatment are available in the clinic. The purpose of this study was to understand the difference in effect between Bi-level Positive Airway Pressure (BiPAP) and an all-purpose nebulizer mask in improving the dyspnea of terminal cancer patients. An observational study with purposive sampling was adopted, with a total of 36 subjects. The dyspnea scores before and after using BiPAP and an all-purpose nebulizer mask were significantly different (Z_(BiPAP)= -4.50, p ＜ .001；Z_(all-purpose) nebulizer = -3.64, p ＜ .001). In addition, BiPAP improved the dyspnea of patients more than the all-purpose nebulizer (Z = -2.65, p ＜ .01). Evaluation of the degree of distress symptoms revealed that the most uncomfortable distress symptoms are the mask being painful and a dry mouth, when using BiPAP and anxiety and dry mouth when using the all-purpose nebulizer mask. According to the overall distress symptom score, the average value for BiPAP was 20.61 ± 6.21 and for the all-purpose nebulizer mask was 8.81 ± 5.39. Both BiPAP and the all-purpose nebulizer mask can relieve dyspnea in patients, but BiPAP results in more serious distress symptoms. In the future, when clinical health care providers are choosing oxygen therapy for terminal cancer patients with dyspnea, they should provide individual care to minimize the effects of discomfort.

並列關鍵字

terminal cancer ； dyspnea ； bi-level positive airway pressure ； all-purpose nebulizer mask

參考文獻

葉旻姍、王麒嘉、廖淑貞(2017)．預防醫療器材導致壓瘡之品質改善研究．健康與建築雜誌，4(2)，81-87。

龍芳、邊苗瑛(2009)．雙相氣道正壓／氣道壓力釋放通氣的原理與應用．呼吸治療，8(1)，51-62。

陳昱芬、黃惠美、陳孟君、徐金菊、張碧華、徐倩儀、張美玉(2015)．建立癌症病人呼吸困難臨床照護指引．榮總護理，32(3)，256-276。

黃詩凌、賴維淑、方素瓔(2018)．運用風扇緩解呼吸困難－系統性文獻回顧與臨床應用．護理雜誌，65(4)，84-93。

Abernethy, A. P., McDonald, C. F., Frith, P. A., Clark, K., Herndon, J. E., 2nd, Marcello, J., . . . Currow, D. C. (2010). Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: A double-blind, randomised controlled trial. Lancet, 376(9743), 784-793.