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  • 學位論文

不同肺擴張訓練法對肺葉切除病患手術後肺部合併症及肺功能的影響

The Effect of Different Lung Expansion Training Methods on Pulmonary Complications and Pulmonary Function in Patients Receiving Lobectomy

指導教授 : 黃秀梨

摘要


肺擴張訓練為臨床上重要護理措施,對胸腔手術後病患肺部合併症的預防與肺功能恢復有重要的影響。國內外文獻缺乏肺擴張訓練對肺葉切除術後病人長期肺部合併症與肺功能影響之相關研究。本研究目的在探討不同的肺擴張訓練方法,對單肺葉切除手術病患術後預防肺部合併症及促進肺功能恢復之影響。研究採類實驗法,以三組實驗組進行縱貫式研究,於台北市一家醫學中心內外科病房預定行常規單肺葉手術的病患為研究對象,收案時間從91年11月4 日至93年3月17日,以隨機取樣法將符合收案的病患分派到深呼吸、Triflo及Couch三組,以重複測量長期收集病患臨床感染與胸部X光資料,並於術前與術後第2、4、6天及術後第14天、術後1.5月及3個月測肺功能,同時於術前與術後第14天及術後1.5月及3個月測6分鐘步行距離。 研究結果發現,在術後肺部合併症方面,除Triflo組胸部X光在第7天到3個月呈現肺炎或肺擴張不全的人數較深呼吸組及Couch組多,達顯著差異外,其餘無顯著差異;在術後肺功能恢復方面,除Triflo組步行前後呼吸困難指數較高,達統計意義外,其餘無顯著差異;肺擴張訓練組別、性別、診斷、術前心肺疾病史、麻醉時間、手術失血量、手術方式、傷口長度、宗教信仰、胸管留置時間、呼吸器使用時間、BMI、加護病房停留時間、術前%FVCpred、%PFpred、 %FEV1pred、肺擴張訓練次數和效力,對術後肺功能恢復的影響有顯著差異;SpO2差異值及心跳差異值與術後肺功能恢復有顯著相關性。本研究結果可提供開胸手術前衛教常規及手術後肺擴張訓練護理常規修改之參考,建議一般術前衛教只需教導深呼吸訓練,誘導性肺量測定訓練僅用於學不會深呼吸訓練技巧的病患,較符合成本效益。

並列摘要


Lung expansion is an important clinical intervention. It plays an important role in the prevention of postoperative pulmonary complication and the recovery of pulmonary function. Few researches focused on the long-term effect of the lung expansion on the prevention of pulmonary complication and the recovery of pulmonary function. This study was to investigate the effect of the different lung expansion training methods on pulmonary complication and pulmonary function in patients receiving lobectomy. In this study, a repeated-measure longitudinal quai- experimental study was employed. The research took place in the medical-surgical units of a medical center in Taipei. All elective probable lobectomy patients were divided into three groups, each receiving preoperative bedside testing of pulmonary function and instruction in the use of three randomly assigned lung expansion methods (deep breath exercise, TrifloII, or Couch2). Repeated lung function tests were provided preoperatively and postoperatively at days 2, 4, 6, two weeks, 1.5 months, and 3 months. And six-minute walk was tested the same time as lung function except postoperatively at days 2, 4, 6. All the patients’ postoperative pulmonary complications, lung function recovery were recorded. Fifty-four patients met the criteria were included. There were no statistical significant differences between three groups in postoperative pulmonary complications, except more Chest X-ray abnormal finding of the TrifloII group postoperatively at days 7 to 3 months. There were no statistical significant differences between three groups in postoperative pulmonary function, except higher dyspnea scale score of the TrifloII group after six-minute walk test. Furthermore, different lung expansion training methods, gender, diagnosis, past cardiopulmonary disease history, duration of anesthesia, blood loss in operation, surgical methods, length of the surgical site, religious, retention time of chest tube, duration of ventilator use, body mass index, length of ICU stay, preoperative pulmonary function(%FVCpred, %PFpred, and %FEV1pred ), frequency of the lung expansion training, and the effort of the lung expansion training would be the influential factors to the recovery of pulmonary function in statistics. The changes SpO2 and heart rate after six-minute walk test would be the predictive indicators of the recovery of pulmonary function. The study showed deep breath exercise group was the most cost-effective lung expansion training in lobectomy patients. Otherwise, some of the lobectomy patients lack the correct deep breath exercise skill after training or surgery. We suggest deep breath exercise training for all preoperative and postoperative lobectomy patients and incentive spirometry as the alternative if lacking the correct deep breath exercise skill.

參考文獻


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被引用紀錄


鄧喬鳳、石燕菁、陳家寶、林宜美、高昭琦、徐莞雲(2013)。降低開胸手術病人使用誘發性肺計量器不完整率改善方案榮總護理30(3),320-328。https://doi.org/10.6142%2fVGHN.30.3.320

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