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  • 學位論文

加護病房存活病人轉出加護病房三個月內的坐到站能力表現

Ability of Sit-to-Stand in Patients Discharged from the Intensive Care units: A Three Months Follow-up Study

指導教授 : 陳佳慧
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摘要


研究背景與目的:加護病房存活病人常見有身體活動功能下降的問題,加護病房治療期間所發生的肌肉乏力或重症系統性乏力可能是主因,而坐到站動作是執行日常生活活動的第一步,從坐到站的表現可以反映出身體活動功能的程度,因此本研究目的欲探討在轉出加護病房三個月後,病人獨立坐到站能力的現況、恢復時間,以及重症系統性乏力的發生是否影響病人坐到站功能恢復。 研究方法:本研究為前瞻性觀察研究,自2019年1月1日至2020年1月31日,以內科加護病房住院時間≧24小時之病人為對象,轉出加護病房48小時內進行重症系統性乏力篩檢、坐到站及身體活動功能的基準值評估,於轉出加護病房後第1、2、3個月,追蹤坐到站及身體活動功能等主要結果指標,所得資料以有無重症系統性乏力進行分組,以Independent T-test、Chi-Square test、Fisher’s exact test及Wilcoxon rank-sum test檢定兩組的基本屬性,考量樣本有重複測量的相依性,故以General estimating equation (GEE)比較兩組之坐到站及身體活動功能的差異,並以Survival analysis分析坐到站的恢復時間點以及兩組之坐到站恢復時間的差異。 研究結果:本研究分析共納入79位病人,其中患有重症系統性乏力共14位,無重症系統性乏力共65位。病人平均年齡67±12.9歲,其中男性居多(59.5%)。以有無重症系統性乏力進行分組,兩組病人在年齡、性別、住院前日常生活活動獨立性、加護病房天數、坐到站獨立性及身體活動功能等均有顯著差異。轉出加護病房三個月內,62%的加護病房存活病人能獨立坐到站,其中50%的病人會在轉出後的一個月發生獨立坐到站,整體而言,轉出加護病房前兩個月是病人恢復獨立坐到站的關鍵期。重症系統性乏力的發生會降低加護病房存活病人的獨立坐到站比率,一旦罹患重症系統性乏力,病人獨立坐到站的勝算會降低81%(p=.04)。轉出加護病房三個月內,50%沒有重症系統性乏力病人會在轉出的第一個月會發生獨立坐到站,而重症系統性乏力病人則未觀察到此現象,重症系統性乏力病人發生獨立坐到站的風險率是沒有重症系統性乏力病人的0.177倍(p=.0038, HR=0.177)。相對於沒有重症系統性乏力病人,重症系統性乏力病人較不容易發生獨立坐到站。在轉出加護病房的第三個月,即便有八成的加護病房存活病人的上下肢肌力已完全恢復,但近三成病人仍無法獨立執行坐到站及原地踏步等功能性活動。 結論:轉出加護病房後,加護病房存活病人無法獨立坐到站的比率並不低,轉出加護病房的前二個月是病人恢復獨立坐到站的關鍵期,重症系統性乏力會增加病人無法獨立坐到站的風險,即便沒有發生重症系統性乏力,在轉出的第一個月,病人的坐到站等功能性活動仍需要額外協助。

並列摘要


Background: The decline of physical activity is a common problem in intensive care unit (ICU) survivors, which was resulted from muscle weakness or intensive care unit acquired weakness (ICU-AW) during the intensive unit care. Sit-to-stand is the key to independent living and to reflect the level of physical activity. This study aims to investigate the status, recovery time, and the effect of ICU-AW on independent sit-to-stand in ICU survivors following three months of intensive care unit discharge. Method: This was a prospective design study. Participants were enrolled in receiving ICU care over 24 hours. Data was collected in the medical ICU of a medical center, from January 1, 2019 to January 31, 2020. As the baseline data, all participants were evaluated within 48 hours after discharged from ICU, which included assessment of ICU-AW, independent sit-to-stand, and physical activity. Afterward, the assessments of independent sit-to-stand and physical activity were conducted on the following 1st, 2ed, and 3rd month. Descriptive statistics were used to analyze baseline demographic variables. The outcomes of the differences between ICU-AW and non- ICU-AW were reported with the independent T-test, Chi-Square test, Fisher’s exact test, and Wilcoxon rank-sum test. Consider repeated measurement, the between-group difference in outcome variables were utilized with General estimating equation. The time event of sit-to-stand and the different recovery time from between-group of sit-to-stand were approached with survival analysis. Result: In total 79 participants completed the survey, of which 14 occurred ICU-AW. The mean age of participants was 67±12.9 years old and males mostly. Group according to with and without ICU-AW, there were significant differences in baseline characteristics (age, gender, Pre-hospitalization ADL independent, length of ICU day, independent sit-to-stand, and physical activity) between groups. Following three months of intensive care unit discharge, 62% of participants were able to achieve sit-to-stand independently, of which 50% of all included participants were able to sit-to-stand independently 1st month after ICU discharge. Overall, the critical period of recovering independent sit-to-stand was the first two months after ICU discharge. Once ICU-AW has occurred, which can decrease 81% odds of independent sit-to-stand in ICU survivors. Despite recovering muscle strength in 80% of participants, there was about 30% of participants failed to sit-to-stand and step cadence independently. Following three months of ICU discharge, 50% of participants performed independent sit-to-stand within the first month in no ICU-AW group; however, those with ICU-AW were absent. Comparing with no ICU-AW group, the participants with ICU-AW had more likely failed to fulfill independent sit-to-stand (p=.0038, HR=0.177). Conclusion: Following three months of ICU discharge, the amount of failed independent sit-to-stand in ICU survivors didn’t report a low percentage. The critical period of recovering independent sit-to-stand was the first two months after ICU discharge. Remarkably, despite without ICU-AW, the physical activity, such as sit-to-stand, in ICU survivors needs additional assistance.

參考文獻


參考文獻
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