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  • 學位論文

充血性心臟衰竭患者運動耐力對其生活品質影響之探討

The Influence of Exercise Tolerance on Quality of Life Among Patients with Congestive Heart Failure.

指導教授 : 鄭綺 陳俊忠 陳保羅
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摘要


運動無耐力是充血性心臟衰竭患者常見的症狀,常影響病患的日常生活。然而目前國內對運動耐力如何影響病人的生活品質之研究相當有限,因此本研究目的在探討充血性心臟衰竭患者之生活品質、運動耐力、以及基本屬性、疾病特徵、運動耐力對生活品質之影響。以立意取樣法選取台北市某教學醫院49位符合選樣條件之充血性心臟衰竭患者為對象,採運動測試(包括運動強度耐力測試及運動時間耐力測試)、Short-Form 36生活品質問卷進行資料收集。資料分析採百分比、平均值、標準差、Spearman correction、 Mann-Whitney U test、Kruskal-Wallis test 及Multiple regression with steps approach。研究結果發現: (一).充血性心臟衰竭患者生活品質總分介於26.63-91.63分,平均值為 67.9分,生活品質屬於中等,且差異性很大。在八個次概念中以因情緒功能引起角色限制(RE)分數最高,活力狀態最差分。(二).充血性心臟衰竭患者運動強度耐力介於1.8-8.3 METs,平均為4.56 METs,顯示個案的體能差異性很大。運動測試終止的原因,以疲憊因素佔最多。50%之HRR運動時間耐力平均為768.55秒(約12.81分) ; 90% HRR之運動時間耐力的運動時間平均為1717.04秒(約28.62分) ; 全程的時間耐力之運動時間平均1923.84秒(約32.05分)。(三).性別、活動狀態與運動耐力無顯著相關。只有年齡與50% HRR之運動時間耐力呈負相關。(四)NYHA層級與運動強度耐力、運動時間耐力呈負相關。在藥物使用方面以單獨服用ACEI藥者之運動耐力最好。(五).年齡、性別、藥物與生活品質在統計上無顯著相關。而活動狀態(即平時有無運動習慣)與活力狀況呈正相關。(六).NYHA層級與生活品質呈負相關。亦即NYHA層級越高,生活品質愈差。NYHA可解釋生活品質總變異量達40.3%。運動強度耐力、運動時間耐力與生活品質呈正相關。(七).運動時間耐力比運動強度耐力更能預測病患之生活品質。本研究証實運動測試對CHF病患是一種安全、可行、有效的耐力評估方法。運動耐力與生活品質習習相關,尤其運動時間耐力之運動訓練更能促進病患的生活品質。

並列摘要


The impact of exercise intolerance on quality of life among patients with congestive heart failure (CHF) is obvious. However, in Taiwan, there are limited studies examining the relationships between exercise tolerance and quality of life. The purpose of this study was to explore the influence of exercise tolerance on quality of life among patients with CHF.An explored-correlated design was used to guide the study. Subjects who met the selection criteria were selected from a medical center of Taipei by purposive sampling. Data was Collected by the Short- Form 36 Questionnaire and treadmill exercise tests, with a fixed protocol and a graded protocol. Percentage, mean, standard deviation, Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation and multiple regression with steps approach were used for data analysis.Research results were shown as following: (1) As a whole, patients had medium quality of life.(2) The average peak VO2 (exercise intensity tolerance) was 4.56METs.The average duration of exercise tolerance were 768.55 seconds, 1717.04 seconds, and 1923.84 seconds at 50% HRR, 90%HRR, and the end of the test, respectively.(3) A significant relationship between age and duration of exercise tolerance at 50% HRR was observed.(4) The New York Heart Association (NYHA) function class, intensity tolerance of exercise and duration tolerance of exercise were significantly correlated with each other.(5) No significant difference was observed between quality of life and age, sex, medicine, but there was a significant positive relationship between activity and vitality.(6) Subjects with higher NYHA function class presented a lower quality of life. The NYHA function class explained 40.3% of the variance in the Quality of life.(7) Duration tolerance of exercise rather than intensity tolerance of exercise can predict quality of life for patients with congestive heart failure.The findings of the study proved that the exercise testing is safe, feasible, and effective for evaluation of exercise tolerance, and should be commended to patients with stable congestive heart failure.

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