臺灣博碩士論文加值系統

經由氣管插管或氣切使用呼吸器輔助呼吸是加護病房病患維持生命極重要的醫療措施之一，但是對於呼吸器依賴的肺塌陷患者，目前的醫療措施效果有限。一些臨床研究報告顯示手動式高度充氣擴肺術可以有效幫助呼吸器依賴肺塌陷患者肺泡回復，呈現痰液清除、通氣量改善、肺塌陷的預防、肺塌陷的部份擴張、順應性改善、動脈氧合增加和呼吸功減少。因此，本研究目的是要驗證對於呼吸器使用一週以上的肺塌陷病患，實施手動式高度充氣擴肺術，在痰液清除和通氣之成效。研究假設為實施手動式高度充氣擴肺術可改善病患之痰液清除和通氣。
本研究使用控制、隨機、單盲的實驗性研究設計。收案場所在北部某醫學中心的胸腔科呼吸治療加護中心，及其建教合作之區域醫院的慢性呼吸治療中心。以簡單隨機方式決定研究對象進入此研究順序的方式，共有28位研究對象完成本研究，實驗組與對照組各14人。實驗組個案接受呼吸器設定型式和手動式高度充氣擴肺術，對照組個案則僅接受呼吸器設定型式。手動式高度充氣擴肺術，每日執行三次、每次20分鐘、一共執行五天。治療效果評值項目共八項，包括病患痰液濕/乾比、痰液黏稠度、潮氣容積、最大吸氣壓、動脈血氧分壓/吸入氧濃度、胸部X光影像、動態順應性和淺快呼吸指標。所有研究對象皆評估三次，收案當天、第三天和第六天，研究結果如下：
（1）痰液清除方面，實驗組病人在痰液黏稠度的得分改變量較對
照組顯著進步，p值為0.002；兩組病患在濕/乾比之進步
程度無顯著差異。
（2）通氣方面，實驗組病人在潮氣容積、最大吸氣壓、動脈血氧
分壓/吸入氧濃度、胸部X光影像及淺快呼吸指標的得分改變
量較對照組顯著改善，p值分別為0.003, 0.05, 0.016, 0.069,
0.008；兩組病患在動態順應性及之進步程度有改善傾向，但
無統計學上顯著差異。

Use of mechanical ventilator support through tracheostomy or intubation has been one of extremely important medical intervention to help support life for ICU patients. However, as the result of using current medical intervention for patients with lung collapse during mechanical ventilation is limited, manual hyperinflation helps alveolar recruitment that results in secretion clearance, ventilation improvement, lung collapse prevention, lung collapse re-inflation, dynamic compliance improvement, artery oxygenation improvement and work of breathing reduction according to certain clinic reports from foreign sources. This study seeks to verify success of sputum clearance and ventilation in giving manual hyperinflation to patients suffering from lung collapse who has been using mechanical ventilation for more than one week. The study takes the assumption that through manual hyperinflation to recruit alveolar, it will help patients sputum clearance and ventilation.
A controlled, randomized, single blind, experimental design was used. Each patient was assigned a random number upon entering the research project, which allowed randomly allocation to two groups: experimental group and control group. The samples were collected in the ICU of a Medical Center in northern Taiwan and the Chronic Respiratory Treatment Center of the Regional Hospital under the cooperation program. A total of 28 patients joined the study in two groups, i.e., experimental group and control group, 14 patients in each group. Cases from the experimental group were treated with ventilation support and additional manual hyperinflation while cases from the control group were only treated with ventilation support. Patients in experimental group received the manual hyperinflation once of 20 minutes in 3 times per day for 5 days.
Outcome measurement was evaluated by noting changes in the patient’s score in dry/wet ratio of sputum, sputum viscosity, tidal volume, maximal respiratory pressure, PaO2/FiO2, upper chest X-ray film, dynamic lung compliance and the index of rapid shallow breathing.
Outcome measurements were assessed 3 times for all patients: at the day admitted to this study, the 3rd day, and 6th day. Upon giving the conclusions are as follows:
(1)For the sputum clearance, patients from the experiment group indicate significant improvement than those from control group does depending on the time-point in terms of sputum viscosity (p=0.002); while patients from both group indicate no significant variance in dry/wet ratio of sputum;
(2)For the ventilation, patients from the experimental group indicate significant improvement than those from control group does depending on the time-point in terms of improved tidal volume (p=0.033), maximal respiratory pressure (p=0.05), PaO2/FiO2 (p=0.016), upper chest X-ray film (p=0.069), the index of rapid shallow breathing (p=0.008); and while patients from both groups indicate no significant variance in terms of dynamic compliance.

第一章緒論
第二章文獻探討
第三章研究方法與步驟
第四章資料分析與結果
第五章討論
第六章結論與建議

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