黏液過度分泌患者施行呼吸道清除護理方案成效之探討

The Efficiency of Nursing Protocol of Airway Clearance on the Patients with Mucus Hypersecretion

何淑娟(S. C. Ho) ； 高紀惠(C. H. Kao) ； 高淑芬(S. F. Kao) ； 郭漢彬(H. P. Kuo)

《長庚護理》 7卷4期 (1996/12) Pp. 26-40

摘要

在臨床上，黏液過度分鉍病患的處置首重呼吸道清除措施。文獻指出，單獨執行姿勢引流或配合其它的胸腔物理治療，對於黏液過度分泌病患能有效的排除痰液問題，但國內一直缺乏這方面的相關研究。本研究的目的在探討呼吸道清除護理方案對黏液過度分泌患者痰液清除能力及通氣氣功能的影響。
本研究採準實驗法，依病患住院先後次序及選案條件選取60位病患分派至實驗組和對照組各30人在兩組均接受姿勢引流與胸部扣擊(PDP)，並利「黏液過度分泌患者呼吸道清除術教手冊」協助個案正確執行呼吸道清除護理措施與注意事項。而研究者針對實驗組患實施用力呼氣技術(FET)普以衛教手冊加以說明。護理方案（PDP或PDP+FET）邊際施行三天共六次，並於住院五天內測定病患的痰液清除能力及通氣功能之變化。
本研究採用Repeated Measures ANOVA比較前測和後測Ⅰ（方案結束後）及後測Ⅱ（方案結束後24小時）之差異。研究結果類示，(1)兩組病患之基本資料無顯著差異。(2)方案實施前兩組病患之痰液清除能力與通氣功能無顯著差異。(3)痰液清除能力方面，在方案實施後四天內兩組病患均顯著改善咳痰難易度及增加痰液咳出量。而實驗組較對照組顯著改善咳痰難易度。(4)實驗組較對照組明穎增加用力肺活量。而兩組病患的第一秒用力吐氣容積、用力肺活量及尖峰吐氣流量每日變化量皆有明顯進步。
本研究發現呼吸道清除護理方案確能增加痰液清除能力與通氣功能。用力呼氣技術在自行操作下可有效改善咳痰難易度及增加用力肺活量，值得於臨床護理推廣應用。

關鍵字

黏液過度分泌 ； 用力呼氣技術 ； 痰液清除能力 ； 通氣功能

並列摘要

The airway clearance is the most importance to the management of the patients with mucus hypersecretion (MH). As emphasized by previous literature, the patients with MH could improve the sputum clearance by postural drainage alone or in combination with other physiotherapy maneuvers. However, there is litter relative research to focus on sputum clearance for the patients with MH. The purpose of this study was to evaluate the efficiency of a nursing protocol of the airway clearance on the sputum clearance and ventilatory function.
A quasi-experimental design was conducted in this study. Sixty patients who met the inclusion criteria selected from the chest ward of a medical center and were divided into experimental (N=30) and control (N=30) groups. Both experimental and control groups received the interventions Postural drainage and percussion (PDP). The nursing protocol of PDP also was given to this two groups to guide the airway clearance for the patients with MH. Forced expiratory technique (FET) was given in the experimental group with a nursing protocol of guidance but not in control group. During the 3 days of the intervention period, subjects received the nursing protocol (PDP or PDP+FET) in 6 times. The airway clearance on the sputum clearance and ventilatory function were tested in the 5-day ward period. Data were analyzed using the Repeated Measures AVOVA. The outcome indicated that: (1) There was no significant difference in basic data between experimental and control groups (2) There were no significant differences between these two groups in the sputum clearance and ventilatory function before th nursing intervention. (3) Both experimental and control groups improved their sputum clearance including the ease of expectoration and the sputum production after 4 days of nursing intervention. The experimental group had a better outcome in the ease of expectoration (4) The experimental group had a better progress in the forced vital capacity. Both experimental and control groups increased the forced expired volume in one-second (FEVI), forced vital capacity (FVC), and peak expiratory flow rate (PEFR).
The findings of this study imply that a nursing protocol of the airway clearance maybe improve sputum clearance and ventilatory function. A self-performance FET can improve the ease of expectoration and increase the forced vital capacity, it is worthy to use the wild-spread in the nursing practice.

並列關鍵字

mucus hypersecretion ； forced expiratory technique ； sputum clearance ； ventilatory function