臺灣博碩士論文加值系統

中文摘要:慢性阻塞性肺病患者長期受困於肺部功能障礙，影響到病患身、心健康問題及生活品質，復健計畫可改善慢性阻塞性肺病患者日常生活功能及生活品質，但所需成本不低，而各項胸腔復健計畫其中例如：上肢體運動其成效仍有爭議，且這些運動並未針對中國人設計，目前國內復健計畫又在起步階段，文獻指出太極拳運動是一種緩和並配合規律腹式呼吸的運動，不僅能增加健康男性的攝氧量，且對於心臟病患第三期復健運動亦能增加最大攝氧量，此外太極拳運動對情緒有正向的影響，故本研究目的在探討瞭解慢性阻塞性肺病患者實行太極拳運動後呼吸困難、肺功能、情緒及運動耐力的成效，實驗型研究設計，在某區域醫院胸腔科門診及復健科心肺復健區門診進行收案，共24位慢性阻塞性肺病患者，隨機分派為實驗組與控制組，實驗組病患接受太極拳運動，為期8週，每週三次，每次約一小時；而控制組依門診常規護理衛教。太極拳運動以鄭氏4式拳法，由太極拳老師指導，研究工具包括肺功能測驗、呼吸困難量表、情緒狀態量表、測六分鐘走路及最大攝氧量測量器。收集的資料採用SPSS 8.0 Window Release統計軟體分析。研究結果發現太極拳運動訓練能顯著改善患者活動及說話時呼吸困難及降低負向情緒；而對於休息時與運動時呼吸困難、用力呼氣第一秒容積／肺活量％、用力呼氣第一秒容積、用力肺活量、最大中段呼氣氣流速度、最大吐氣流速及運動耐力未達到顯著地差異。研究發現，病患在執行太極拳運動時不受時間及場地限制，又能發展本土化復健運動，可提供護理人員給予病患住院或居家照護時肺部復健運動計畫之參考，並可納入在職教育或復健護理課程中推廣。

ABSTRACT
Chronic Obstructive Pulmonary Disease (COPD) patients suffer from a long-term lung disorder that influences their physical and mental health, and living quality. Rehabilitation can improve the patients'' vital functions and living quality, but the costs involved are very high and the effects of thoracic therapy, such as upper limb exercise, are disputed. Moreover, these exercises are not culturally designed for Chinese patients, and this therapy in Taiwan was only recently introduced. Tai Chi chuan is a sport that alleviates and coordinates abdominal respiration. It not only increases oxygen intake in healthy men, but also increases maximal oxygen intake (VO2max) in heart patients in the third phase of therapy. Tai Chi chuan also has positive effects on mood swings. Therefore, the objective of this study was to examine the effect of Tai Chi Chuan on dyspnea, lung function, mood and stamina in COPD patients. This study used an experimental research design and was performed at the outpatient chest department and the outpatient department of respiratory therapy, department of physical medicine and rehabilitation of a certain regional hospital. Twenty-four COPD patients were enrolled in the study and randomly assigned to a treatment group and a control group. Patients in the treatment group were subjected to Tai Chi Chuan exercise over a period of eight weeks, three times a week, one hour each time. Patients in the control group were subjected to conventional treatment methods. The Tai Chi Chuan exercises were based on Cheng''s Four-Style Tai Chi Chuan and taught by a Tai Chi chuan instructor. Measurement tools included lung function testing, respiratory dysfunction tables, mood phase tables and a six-minute walk to measure VO2max. The collected data were analyzed using SPSS 8.0. Window Release Results showed that Tai Chi chuan improved patients dyspnea at speech and action, reduced mood swings. No significant difference was found for dyspnea at rest and in exercise, FEV1/FVC%, first second forced expiration volume (FEV1), forced vital capacity (FVC%) and Maximum Forced Expiratory Flow Rate (FEF25-75%) and Maximum Forced Expiratory Flow Rate values, exercise tolerance. In this study, patients were not restricted by time or location in performing Tai Chi Chuan. Tai Chi Chuan can be developed into an indigenous type of therapy for COPD. Medical personnel can use Tai Chi Chuan as an option for pulmonary therapy for both inpatients and outpatients. It can be included in professional training of medical personnel and in courses for physical medicine and rehabilitation.

目 錄
頁次
致謝.................................................................................................................................................................................................... Ⅰ
中文摘要........................................................................................................................................................................................... Ⅱ
英文摘要.......................................................................................................................................................................................... Ⅳ
目錄.................................................................................................................................................................................................... Ⅵ
圖表目錄.......................................................................................................................................................................................... Ⅷ
第一章 緒論
研究背景與重要性....................................................................................................................................................... 1
研究目的......................................................................................................................................................................... 3
研究假設........................................................................................................................................................................ 3
概念架構.......................................................................................................................................................................... 4
名詞界定......................................................................................................................................................................... 5
第二章 文獻查證
慢性阻塞性肺疾疾病患者之肺功能.......................................................................................................................... 9
慢性阻塞性肺疾疾病患者之呼吸困難概況............................................................................................................ 11
慢性阻塞性肺疾疾病患者之情緒概況..................................................................................................................... 14
慢性阻塞性肺疾疾病患者之運動耐力.....................................................................................................................18
慢性阻塞性肺病病患之呼吸困難、肺功能、情緒、運動耐力間關係.............................................................20
慢性阻塞性肺疾疾病患者之太極拳概況................................................................................................................ 22
第三章 研究方法
研究設計......................................................................................................................................................................... 28
研究對象及樣本數....................................................................................................................................................... 29
研究工具及信效度檢定...............................................................................................................................................41
研究步驟.........................................................................................................................................................................41
資料分析.........................................................................................................................................................................45
第四章 研究結果
慢性阻塞性肺疾疾病患者之基本屬性.....................................................................................................................46
太極拳運動介入對慢性阻塞性肺疾病患者之影響...............................................................................................56
第五章 討論 頁次
太極拳運動介入對慢性阻塞性肺疾病患者呼吸困難之影響.............................................................................. 76
太極拳運動介入對慢性阻塞性肺疾病患者肺功能之影響.................................................................................. 77
太極拳運動介入對慢性阻塞性肺疾病患者情緒之影響...................................................................................... 78
太極拳運動介入對慢性阻塞性肺疾病患者運動耐力之影響.............................................................................. 78
第六章 結論與建議
結論.................................................................................................................................................................................. 79
研究限制......................................................................................................................................................................... 80
建議................................................................................................................................................................................. 81
參考資料 ........................................................................................................................................................................................... 83
附錄
附錄一 研究工具之內容效度專家名單................................................................................................................................... 98
附錄二 研究說明書....................................................................................................................................................................... 99
附錄三 同意書...............................................................................................................................................................................100
附錄四 研究工具......................................................................................................................................................................... .101
附錄五 量表原作者同意書.........................................................................................................................................................108
附錄六 研究之「慢性阻塞性肺疾病太極拳運動手冊」................................................................................................... .118
附錄八 慢性阻塞性肺疾病患者原始資料..............................................................................................................................128
圖表目錄 頁次 圖1 概念架構圖....................................................................................................................................................................... 4
圖2 資料收集流程.................................................................................................................................................................44
圖3-1 兩組休息時呼吸困難前後測得分............................................................................................................................. 59
圖3-2 兩組運動時呼吸困難前後測得分............................................................................................................................. 59
圖3-3 兩組呼吸困難量表前後測得分..................................................................................................................................59
圖4-1 兩組FVC前後測值........................................................................................................................................................64
圖4-2 兩組FVC%前後測.........................................................................................................................................................64
圖4-3 兩組FEV1前後測值...................................................................................................................................................... 65
圖4-4 兩組FEV1%前後測值....................................................................................................................................................65
圖4-5 兩組FEV /FVC%.............................................................................................................................................................65
圖4-6 兩組PEF25-75前後測值................................................................................................................................................66
圖4-7 兩組PEFR前後測值...................................................................................................................................................... 66
圖5 兩組情緒狀態剖析前後測得分................................................................................................................................. 68
圖6-1 兩組VO2升／分前後測得分.......................................................................................................................................73
圖6-2 兩組VO2 升／分 百分比前後測得分........................................................................................................................ 73
圖6-3 兩組單位體重攝氧量前後測得分............................................................................................................................. 73
圖6-4 兩組單位體重攝氧量百分比前後測得分................................................................................................................74
圖6-5 兩組MET前後測得分...................................................................................................................................................74
圖6-6 兩組六分鐘走路前後測得分......................................................................................................................................74
表 1 完成者與中斷者研究對象基本資料之比較............................................................................................................31
表 2 完成者與中斷者研究對象疾病相關屬性之比較...................................................................................................32
表 2續 完成者與中斷者研究對象疾病相關屬性之比較...................................................................................................33
表 3 完成者與中斷者研究對象呼吸困難測試得分、肺功能測試得分、情緒狀態得分及運動耐力測試得分之比
較.....................................................................................................................................................................................34
表 4 實驗組與控制組FEV1%、FEF25-75數值轉換前後之平均值及標準.................................................................46
表 5 實驗組與控制組研究對象基本資料之比較...........................................................................................................48
表 6 實驗組與控制組研究對象疾病相關屬性之比較..................................................................................................51
表 7 慢性阻塞性肺疾病患者實驗組與控制組研究對象前測呼吸困難測試得分、肺功能測試得分、情緒狀態得分及運動耐力測試得分之比較...................................................................................................................................................53
表 8 實驗組與控制組呼吸困難測試及情緒狀態測試得分指標分析.......................................................................55
表 9 實驗組與控制組呼吸困難得分重複測量雙因子變異數分析...........................................................................58
表10 實驗組與控制組肺功能測試重複測量雙因子變異數分析...............................................................................62
表10續 實驗組與控制組肺功能測試重複測量雙因子變異數分析................................................................................63
表11 實驗組與控制組肺功能測試結果之比較..............................................................................................................64
表12 實驗組與控制組情緒狀態得分重複測量雙因子變異數分析...........................................................................67
表13 實驗組與控制組運動耐力得分重複測量雙因子變異數分析.............................................................................71
表13續 實驗組與控制組運動耐力得分重複測量雙因子變異數分析............................................................................72

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