分析手臂運動訓練對病人脫離呼吸器之成效

Ventilator Weaning: The Effectiveness of Arm Exercise Training

童惠芳(Hui-Fang Tang) ； 白玉珠(Yu-Chu Pai) ； 林柏瑤(Po-Yao Lin) ； 陳美娟(Mei-Chuan Chen) ； 蔡雅琪(Ya-Chi Tsai)

《護理暨健康照護研究》 8卷2期 (2012/06) Pp. 138-148

https://doi.org/10.6225/JNHR.08.2.138

摘要

背景：在病人脫離呼吸器過程中儘早實施手臂運動訓練，以增進呼吸肌強度，此訓練對於脫離呼吸器之影響力值得關注。目的：瞭解及分析手臂運動訓練對病人成功脫離呼吸器之成效。方法：本研究為類實驗研究法，對象為台灣北部某醫學中心加護病房使用呼吸器病人，採隨機取樣，分為訓練組及對照組各收案75人，訓練組在病況穩定即執行手臂運動訓練，對照組維持原有照護模式，研究工具為結構式量表，包括病人呼吸器脫離評估及主觀感受量表。結果：研究結果顯示訓練組住加護病房天數比對照組少8天，使用呼吸器天數少15.5天，醫療費用平均少132,318元，呼吸器脫離率100%，對照組68%；在主觀感受得分方面，訓練組正向情感得分高於對照組，負向情感得分低於對照組。手臂運動訓練後，訓練組病人最大吸氣壓顯著增加11.1cmH（下標 2）O，最大吐氣壓顯著增加15.8 cmH（下標 2）O，潮氣容積顯著增加82.7ml，最大通氣量顯著增加112.3ml，每分鐘換氣量亦顯著增加1L，訓練組淺快呼吸指數較對照組顯著低14.3min／L。以邏輯斯迴歸分析成功脫離呼吸器之預測因子，發現手臂運動訓練每增加一天，成功脫離率增加22.4%。結論／實務應用：研究結果發現手臂運動訓練提高病人之呼吸器脫離率成效佳，建議給予病人手臂運動訓練，協助病人脫離呼吸器，增進生活品質及節省醫療費用。

關鍵字

手臂運動訓練 ； 脫離 ； 呼吸器

並列摘要

Background: Weaning ventilator programs include arm exercise training to improve patient respiratory muscle strength. The effectiveness of such training should be evaluated in light of expected results.Purpose: This research evaluated the effectiveness of arm exercise training in a weaning ventilator program.Methods: We adopted a quasi-experiment methodology. Subjects were patients on ventilators recruited from an ICU (intensive care unit) at a medical center in Taipei, Taiwan. We randomly divided subjects between training and control groups containing a total of 75 subjects each. Training group subjects received arm exercise training; Control group subjects received standard nursing care. Constructive scales used to collect data included a demographics questionnaire, ventilator weaning assessment scale, and subjective perception scale.Result: Results showed that numbers of ICU and ventilator days, medical costs, and RSI (rapid shallow breathing index) were all significantly lower in the training group than the control group; The weaning rate of the training group was higher (100% vs. 68%); The subjective perception scale of the training group was significantly higher than the control group, especially in the positive emotion domain. After arm exercise training, Pimax increased 11.1 cmH(subscript 2)O, Pemax increased 15.8 cmH(subscript 2)O, tidal volume increased 82.7 ml, maximal ventilation increased 112.3ml, and minute ventilation increased 1L. We constructed a logistic regression model to predict factors involved in successful ventilator weaning. We found the rate of weaning success increased an average 22.4% for every arm training exercise day.Conclusion: Arm exercise training significantly increased the weaning rate. The training program assisted patients to wean from their ventilator as soon as possible, improved patient quality of life, and effectively reduced medical resource expenditures.

並列關鍵字

arm exercise ； weaning ； ventilator

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