冠狀動脈繞道術病患接受住院期跑步機心臟復健運動計劃成效之探討

The Effectiveness of Inpatient Cardiac Rehabilitation (Treadmill Exercise) Program on Patients with Coronary Artery Bypass Graft

陳玉蘭(Chen Yu-Lan)

指導教授 ： 鄭綺

臺北醫學大學/護理學院/護理學研究所/碩士(2001年)

摘要

心臟復健的實行在歐美相當普及，在國內尚為起步階段，目前國內對住院期開心病人的復健運動，大都是以日常生活活動訓練或慢步行走為主，在實際執行上較為繁瑣困難，無法明確評估其耐力進展。所以本研究在探討以較積極、可量化的跑步機復健運動計劃，對心臟手術病患體能、疲憊感、日常活動的執行與自我效能的影響，希望能藉由研究確立此心臟復健運動計畫之成效與益處，進而將此心臟復健運動計劃做全面化的推行。 本研究從民國89年10月到民國90年6月，共計9個月，採立意選樣法，於台北某一教學醫院心臟科病房選取接受冠狀動脈繞道術術後的開心病患，以跑步機心臟復健運動計劃介入為自變項，因變項包括：6分鐘最大行走距離、疲憊感受與活力知覺得分、日常活動自我效能得分及日常活動進展，分別以 6-minutes walk test、日常活動進展量表、日常活動自我效能量表及疲憊問卷量表檢測。追蹤測試的時間分別是出院時及出院後一週與四週。資料分析採平均數、標準差、百分比、repeated measurement、correlation、t test 及ANOVA。 研究結果顯示﹙一﹚冠狀動脈繞道術者，術後平均住院天數為8天，要達到4.5mets的活動量平均是手術後7.8天。﹙二﹚術後平均第2.72天完成1.5mets﹙stageⅠ﹚的活動訓練，第3.88天完成2.0mets﹙stageⅡ﹚的活動量，第5.24天完成第一次的跑步機運動訓練﹙2.5mets , stageⅢ﹚，第6.25天完成3.0mets﹙stageⅣ﹚的訓練，第6.87天完成3.7mets﹙stageⅤ﹚的訓練，第7.8天完成4.5mets﹙stageⅥ﹚的訓練。﹙三﹚各階段運動訓練要達百分之百完成率，在手術後的日數分別是：stageⅠ術後第5日、stageⅡ術後第6日、stageⅢ術後第9日、stageⅣ術後第10日、stageⅤ術後第9日、stageⅥ術後第9日。﹙四﹚影響運動訓練執行的延緩因素有術後肋膜積水、心跳過快、心房纖維顫動、皮下氣腫、發燒等醫療性因素，與傷口疼痛、頭暈、虛弱。﹙五﹚男性、無糖尿病、氣管內管24小時內拔除者較早進入跑步機的使用階段﹙stageⅢ﹚。﹙六﹚個案出院後6分鐘最大步行距離、疲憊感受與自我效能在出院後一週與出院後四週都有顯著進步。兩階段的進步幅度量並未達統計上顯著差異。﹙七﹚出院到出院後一週與出院到出院後四週，此二階段的自我效能進步幅度與跑步機首次使用日數成正相關。﹙八﹚出院後之日常活動進展以爬一層樓﹙5.5mets﹚為指標，在出院第一週時，78.38 % 個案完成，到出院第四週時100 % 個案，可在完全不費力之下完成該活動。﹙九﹚出院時最高活動met 數，對出院後6分鐘最大步行距離、疲憊感受、活力知覺與自我效能的進步幅度無影響，但是與出院後一週的自我效能得分呈正相關。 本計畫在執行上是可行的，活動量在出院時最大可達 4.5 mets，較以往國內的 3.0 或 3.5 mets活動量，更是接近美國運動醫學會（ACSM）的建議。

關鍵字

冠狀動脈繞道術患者 ； 住院期心臟復健運動計劃

並列摘要

Cardiac rehabilitation program is commonly performed in America and Europe, whereas in Taiwan, it still is in a beginning level. Therefore, the purpose of this study was to design an aggressive and countable inpatient cardiac rehabilitation （treadmill exercise） program for patients with coronary artery bypass graft, and to examine the influences of the program on the physical endurance, performance of ADL, self-efficacy of ADL, and fatigue. This study was conducted from Oct. 2000 to Aug. 2001. Twenty-fifth subjects who met the selection criteria were selected by purposive sampling from a teaching hospital in Taipei. The independent variable was the exercise program and the dependent variables included a maximal distance by using a 6-minute walk test, fatigue, self-efficacy, and the ADL. The data were collected at the 1st week and 4th week after discharge from hospital by the 6-minute walk test, the Fatigue/Stamina scale, the Activity Self-Efficacy scale and the Duke Activity Index. Data was analyzed by percentage, mean, standard deviation, t test, one-way ANOVA, correlation, and repeated measurement. The major finding of this study were as follows ： 1. The average time in hospital was 8 days after CABG. It took 7.8 days after operation to complte the stage Ⅵ （4.5 METs） of the program. 2. The average days for completing each stage was 2.72 days （stageⅠ, 1.5 METs）, 3.88 days （stageⅡ, 2.0 METs）, 5.24 days （stageⅢ, 2.5 METs, as first treadmill’s using）, 6.25 days （stageⅣ, 3.0 METs）, 6.87 days （stageⅤ, 3.7 METs）, and 7.8 days（stageⅥ, 4.5 METs）. 3. Patients in every stage of training achieved 100 ﹪completion, the average day of completion was stageⅠ at 5th day after operation, stageⅡ at 6th day after operation, stageⅢ at 9th day after operation, stageⅣ at 10th day after operation, stageⅤ at 9th day after operation, stageⅥ at 9th day after operation. 4. The major reasons for prolonging the progression of exercise training were plural effusion, tachycardia, atrial fibrillation, subcutaneous emphysema, fever, chest wall’s wound pain, dizziness, and weakness. 5. The thired stage of the program was started early in patients who are male, non-diabetes and the endotracheal tube removed in 24 hours after operation. 6. After discharge, the maximal walking distance, self-efficacy, fatigue and stamina were significantly improved at the 1st week and 4th week after discharge from the hospital. 7. From discharge to after discharge 1st week and from after discharge 1st week to 4th week, these two section increased percentages of the self-efficacy scores with the first treadmill’s use shows a significant positive correlation. 8. One week after discharge from hospital, 78.38 ﹪of patients may perform 5.5 METs ADL. Four weeks after discharge from hospital, 100 ﹪of patients may perform the same level of ADL without complaint. 9. The maximal performed at discharge was significantly correlated with the self-efficacy scores at the 1st week after discharge. It was concluded that the patients who undergone the inpatient cardiac rehabilitation（treadmill exercise）program can perform higher intensity in daily activities than the patients who received the general inpatient cardiac rehabilitation programs.

並列關鍵字

coronary artery bypass graft ； inpatient cardiac rehabilitation program

參考文獻

鄭綺(1999)．冠狀動脈繞道術患者最大攝氧量、自覺體能效能及生活品質之探討．護理研究，7(6)，531-541。

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