臺灣博碩士論文加值系統

臨床常用簡便的吸氣肌訓練器可分為兩大類：閥值負荷型訓練器 ( pressure threshold inspiratory muscle trainer) 與阻力型訓練器(resistive inspiratory muscle trainer)。閥值負荷型訓練器的阻力則來自加裝附有彈簧的活塞。阻力型訓練器是利用進氣端所加裝直徑不同的阻力洞以增加呼吸時的阻力。目前並無比較兩者於慢性阻塞性肺部疾病患者訓練成效的文獻，因此本研究的目的在於比較不同阻力性質的訓練器對慢性阻塞性肺部疾病患者的吸氣肌肌力及耐力的訓練效果以及對功能性運動能力、呼吸困難症狀及生活品質的改變。由胸腔內科醫師轉介42名診斷為中度到嚴重慢性阻塞性肺部疾病患者，在評估後給予受試者約半小時的胸腔物理治療衛教，將受試者分為3組，第一組為控制組，不提供吸氣肌訓練器，簡稱C組（control group）；第二組使用閥值負荷型訓練器訓練，簡稱T組(threshold load group)；第三組以加裝激勵型流量計做為回饋裝置來控制流速的阻力型訓練器訓練，簡稱TR組（targeted resistive load group）。兩個訓練組接受為期8週，每天2次，每次15分鐘，強度為50﹪最大吸氣壓(maximal inspiratory pressure，MIP)的吸氣肌訓練。
受試者在訓練前接受第一次測試，8個星期後接受第二次測試，測試項目包括基本資料、用力肺活量(forced vital capacity, FVC)及第一秒用力吐氣流量(forced expiratory volume in one second, FEV1) 、最大吸氣壓、吸氣肌耐力時間(endurance time)、6分鐘行走測試、運動時Borg 呼吸困難指數及健康相關生活品質測量（SF-36）。以敘述性統計說明受試者的一般資料；以Wilcoxon Signed Rank test檢驗同一組之最大吸氣壓，吸氣肌耐力時間，6分鐘行走距離在八週前後的差異；以Kruskal Wallis test比較三組間在訓練前基本資料的差異；分析三組在最大吸氣壓、吸氣肌耐力時間、6分鐘行走距離、呼吸困難指數、健康相關生活品質測量問卷之結果在八週前後之差異值。再以Spearman’s Correlation檢定分析各變數之間的相關性。共有30名受試者完成前後兩次測試，結果顯示中重度慢性阻塞性肺部疾病患者使用2種不同吸氣肌訓練器，經過8星期阻力為50%MIP的吸氣肌訓練後，與控制組相比，在70%MIP的阻力下可以維持呼吸的耐力時間有顯著的增加(p＜0.05)，T組與TR組間無明顯差異。訓練前後T組與TR組之最大吸氣壓和6分鐘行走距離增加(p＜0.05)，但3組間未達統計上之顯著意義。控制組在前後兩次測試中僅發現最大吸氣壓值有增加，其餘測量參數則無變化。三組在兩次SF-36健康相關生活品質問卷得分並無改變。耐力時間則與FEV1 (%pred) 成正相關，與休息時呼吸困難指數呈負相關，p值均<0.05；6分鐘行走距離與問卷中「生理功能」、「社會功能」成正相關，兩次最大吸氣壓差值與耐力時間差值、行走測試距離差值都成正相關，p<0.05。

目錄
頁碼
摘要……………………………………………………………………………1
第一章、前言
第一節、研究背景……………………………………………………………3
第二節、研究目的……………………………………………………………5
第三節、研究假說……………………………………………………………5
第四節、研究的顯著性………………………………………………………6
第五節、研究限制……………………………………………………………6
第六節、使用名詞定義………………………………………………………7
第二章、文獻回顧
第一節、呼吸肌訓練的理論…………………………………………………8
第二節、不同形式吸氣肌訓練儀的原理與其應用於慢性阻塞性肺疾病患者的訓練成效……………………………………………………………………10
第三章、材料與方法
第一節、研究設計……………………………………………………………13
第二節、受試者………………………………………………………………13
第三節、儀器與測試程序……………………………………………………15
第四節、吸氣肌訓練…………………………………………………………19
第五節、統計分析方法………………………………………………………20
第四章、結果
第一節、一般肺功能…………………………………………………………21
第二節、吸氣肌肌力…………………………………………………………22
第三節、吸氣肌耐力…………………………………………………………24
第四節、功能性運動能力-6分鐘行走測試…………………………………25
第五節、呼吸困難指數………………………………………………………28
第六節、健康相關生活品質：SF-36健康相關生活品質問卷……………29
第七節、各評估項目間之相關性……………………………………………30
第五章、討論
第一節、吸氣肌肌力…………………………………………………………33
第二節、吸氣肌耐力…………………………………………………………35
第三節、功能性運動能力-6分鐘行走測試…………………………………37
第四節、呼吸困難指數………………………………………………………40
第五節、健康相關生活品質：SF-36健康相關生活品質問卷……………42
第六節、各評估項目間之相關性……………………………………………45
第七節、吸氣肌訓練器使用上的相關問題 ………………………………47
第六章、結論…………………………………………………………………49
第七章、參考文獻……………………………………………………………50
第八章、圖表
表1. 慢性阻塞性肺疾病患者的呼吸肌訓練…………………58
表2. 阻力型呼吸肌訓練器不同孔徑圓盤之阻力大小………59
表3. 受試者基本資料…………………………………………60
表4. 肺功能檢查結果…………………………………………61
表5. 不同組間藥物使用狀況…………………………………62
表6. 訓練前後呼吸肌肌力、耐力……………………………63
表7. 訓練前後呼吸肌肌力、耐力變化………………………64
表8. 每週最大吸氣壓紀錄……………………………………65
表9. 6分鐘行走測試結果……………………………………66
表10. 訓練前後6分鐘行走測試差異…………………………67
表11. 6分鐘行走測試前後Borg呼吸困難指數的改變人次表68
表12. 6分鐘行走測試前後Borg呼吸困難指數的改變………69
表13. 訓練前後SF-36健康相關生活品質問卷量表結果……70
表14. 訓練前後SF-36健康相關生活品質問卷量表差異……71
表15. SF-36健康相關生活品質問卷「生理功能」領域題目得
分人次........................................72
表16. 第一次最大吸氣壓、耐力時間、FVC、FEV1之相關性.73
表17. 第一次六分鐘行走測試各變數與最大吸氣壓、耐力時
間、FVC（%pred）、FEV1（%pred）、生理功能之相關
性…………………………………………………………74
表18. 第一次六分鐘行走測試各變數之相關性………………75
表19. SF-36健康相關生活品質問卷各項目與FVC、FEV1、最大
吸氣壓、耐力時間、行走距離、休息時Borg 給分、測
試後Borg 給分間之相關性………………………………76
表20. SF-36健康相關生活品質問卷各項目間之相關性……77
表21. 最大吸氣壓差、耐力時間差、行走距離差、休息時呼吸
困難指數差、測試後呼吸困難指數差、「生理功能」差
與FVC（%pred）、FEV1（% pred）、第一次測試最大吸
氣壓、耐力時間之相關性………………………………78
表22. 前後兩次測試最大吸氣壓差、耐力時間差、行走距離
差、休息時呼吸困難指數差、測試後呼吸困難指數差、
「生理功能」差與六分鐘行走測試各參數間之相關
性…………………………………………………………79
表23. 前後兩次測試最大吸氣壓差、耐力時間差、行走距離
差、休息時呼吸困難指數差、測試後呼吸困難指數差、
生理功能差與SF-36健康相關生活品質問卷各項目得分之
相關性……………………………………………………80
表24. 最大吸氣壓差、耐力時間差、行走距離差、休息時呼吸
困難指數差、測試後呼吸困難指數差與生理功能差各變
數間的相關性……………………………………………81
表25.「生理功能」差與SF-36健康相關生活品質問卷各項目得
分差間之相關性…………………………………………82
圖1. 閥值負荷型訓練器………………………………………83
圖2. 加裝激勵型流量計的阻力型訓練器……………………84
圖3. 使用加裝激勵型流量計的阻力型訓練器的方法………85
圖1. 訓練前後吸氣肌肌力(最大吸氣壓)之變化……………86
圖2. 訓練前後不同組間吸氣肌耐力時間之變化……………87
圖3. 不同組間訓練前後6分鐘行走距離之變化……………88
第九章、附件
附件1. 同意書……………………………………………………………89
附件2. 受試者記錄表……………………………………………………92
附件3. Borg 呼吸困難指數……………………………………………93
附件4. 病人健康相關生活品質測量(SF-36)問卷……………………94
附件5. 居家呼吸訓練記錄表……………………………………………99
附件6. 每週最大吸氣壓測量及訓練阻力紀錄………………………100

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