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研究生:林韋君
研究生(外文):Wei-Chun
論文名稱:呼吸訓練對慢性阻塞性肺疾病患者肺功能、活動耐受度及生活品質之影響
論文名稱(外文):The Effects of Respiratory Training on Lung Function, Activity Tolerance and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease
指導教授:袁素娟袁素娟引用關係
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2010
畢業學年度:98
語文別:中文
論文頁數:93
相關次數:
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研究背景:肺部復健能增加慢性阻塞性肺疾病患者的活動耐受度及改善心理情緒,可緩解呼吸困難感受,及提升整體生活品質。呼吸訓練是簡單易行的肺部復健運動,如納入患者生活常規,將是一大助益。研究目的:本研究探討呼吸訓練對慢性阻塞性肺疾病患者的肺功能、活動耐受度及生活品質之影響。研究方法:隨機臨床實驗研究設計(Randomized clinical trials research design),於98年6月15日至同年11月15日期間,以中台灣某區域教學醫院胸腔內科門診按時於門診追蹤治療之慢性阻塞性肺疾病患者為研究對象,以時間隨機分為介入組(N = 17)及對照組(N = 14),進行資料收集。呼吸訓練措施介入三個月,介入前後兩組均以肺量計、聖喬治呼吸問卷及六分鐘走路距離等工具測量,資料整理後,以SPSS 16.0套裝軟體進行統計分析。研究結果:兩組個案之基本屬性具同質性,介入組在執行呼吸訓練後其肺功能參數FVC (p = 0.019)、FEV1 (p = 0.001)、FEV1百分比預測值(p = 0.002)皆有顯著進步,兩組前後測值之差,介入組FEV1 (p = 0.016)與FEV1百分比預測值(p = 0.01)顯著優於對照組;活動耐受度方面,介入組六分鐘走路距離增加49.71公尺(p = 0.007),六分鐘走路距離百分比預測值增加9.65 % (p = 0.009),對照組六分鐘走路距離減少19.07公尺(p = 0.248),六分鐘走路距離百分比預測值降低3.5 % (p = 0.306);生活品質方面,介入組之聖喬治呼吸量表症狀部分(p = 0.026)、衝擊部分(p = 0.001)及整體總分(p < 0.001)皆有顯著改善,對照組並無顯著差異(p > 0.05),兩組前後測值之差活動部分(p = 0.039)、衝擊部分(p = 0.001)及整體總分(p < 0.001)達顯著差異;BODE index方面,介入組指數有顯著下降(p = 0.004),對照組則無顯著差異(p = 0.48),兩組前後測差亦達顯著差異(p = 0.002);影響呼吸訓練成效之因素方面,組別對於肺功能成效(R2  = 0.166, p = 0.023)、活動耐受度成效(R2  =0.239, p = 0.005)及生活品質成效(R2  = 0.338, p = 0.001)有顯著影響,每日抽菸包數對於活動耐受度成效亦有顯著影響(R2  = 0.109, p = 0.039)。研究結論:呼吸訓練可緩解呼吸困難,有益於維持肺功能,增加活動耐受度,並改善生活品質,呼吸訓練可作為慢性阻塞性肺疾病患者復健方案之常規,並提供醫護人員照護之參考。

Background:Pulmonary rehabilitation can increase activity tolerance and improve psychological state, which not only can relieve dyspnea but also can improve the quality of life of patients in chronic obstructive pulmonary disease. Respiratory training is an easy pulmonary rehabilitation exercise. If it is made into part of the patient''s life routine, it will be beneficial. Purpose:This study aims at exploring the effects of respiratory training on lung function, activity tolerance and quality of life in patients with chronic obstructive pulmonary disease. Methods:It is a randomized clinical trials research design with collect the data from the clinic of chest medicine of regional teaching hospital in central Taiwan from June 15, 2009 to November 15, 2009. The subjects of intervention group (N = 17) and control group (N = 14) were randomly assigned. They suffered from chronic obstructive pulmonary disease and received regular treatment at clinic department. The intervention group received respiratory training program for three months. The spirometry, St. George’s respiratory questionnaire and six minutes walk distance are used to measure the intervention group and control group before and after the respiratory training. SPSS 16.0 software was used to analyze the statistical data. Results:Two groups were similar at baseline. The lung function parameters of patients in the intervention group including: FVC (p = 0.019)、FEV1 (p = 0.001)、FEV1 % predicted (p = 0.002) were significantly improve after respiratory training . In the change of pretest with posttest of two groups, the FEV1 (p = 0.016) and FEV1 % predicted (p = 0.01) of intervention group was significantly better than control group. In activity tolerance, patients in the intervention group increased in six minute walk distance about 49.71 m (p = 0.007) and six minute walk distance % predicted about 9.65 % (p = 0.009), patients in the control group decreased in six minute walk distance about 19.07 m (p = 0.248) and six minute walk distance % predicted about 3.5 % (p = 0.306). In quality of life, patients in the intervention group was significantly improve in symptoms section (p = 0.026), impact section (p = 0.001) and total score (p < 0.001) of St. George’s respiratory questionnaire, but the control group was not (p > 0.05), and the change of pretest with posttest of two groups were significant difference in the activity section (p = 0.039), impact section (p = 0.001) and total score (p < 0.001). In the BODE index, patients in the intervention group was significantly decrease in the score (p = 0.004), but the control group was not (p = 0.48), and the change of pretest with posttest of two groups were significant difference (p = 0.002) also. In the influence factors of the effect of respiratory training, the group was significantly predicting in effect of lung function (R2  = 0.166, p = 0.023), activity tolerance (R2  =0.239, p = 0.005), and quality of life (R2  = 0.338, p = 0.001), the pack of daily smoking was significantly predicting in effect of activity tolerance (R2  = 0.109, p = 0.039) also. Conclusions:The research result revealed that respiratory training can relieve dyspnea, maintain lung function, increase activity tolerance and improve quality of life. This method of respiratory training could be a routine of the rehabilitation program of chronic obstructive pulmonary disease, and offer the reference for medical personnel who are caring this kind of patient.

目錄
摘要 I
Abstract III
第壹章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 3
第三節 研究問題 3
第四節 研究假說 3
第五節 名詞界定 4
第貳章 文獻查證 6
第一節 慢性阻塞性肺疾病 6
第二節 肺功能 9
第三節 活動耐受度 13
第四節 生活品質 15
第五節 呼吸訓練 18
第六節 慢性阻塞性肺疾病介入措施之相關研究 21
第七節 研究架構 27
第叁章 研究方法 28
第一節 研究設計 28
第二節 研究地點、對象及取樣 29
第三節 研究工具 31
第四節 介入措施 35
第五節 資料收集方法及步驟 37
第六節 資料統計分析 39
第七節 研究倫理考量 39
第肆章 研究結果 40
第一節 研究對象基本屬性 40
第二節 呼吸訓練對肺功能之成效 45
第三節 呼吸訓練對活動耐受度之成效 47
第四節 呼吸訓練對生活品質成之效 49
第五節 呼吸訓練對BODE index之成效 51
第六節 影響呼吸訓練成效之因素 52
第伍章 討論 56
第六章 總結 60
第一節 結論 60
第二節 建議 61
第三節 研究限制 62
第四節 未來研究方向 63
參考資料 64
一、中文部分 64
二、英文部分 66
附錄一、臨床醫學倫理委員會函 73
附錄二、臨床試驗受試者說明及同意書 75
附錄三、結構式問卷之個案基本屬性表 78
附錄四、聖喬治呼吸量表 79
附錄五、BODE Index 82
附錄六、呼吸訓練衛教單 83
附錄七、肺部復健運動日記 85
附錄八、專家效度審查名單 86
附錄九、結構式問卷之基本屬性內容效度 87
附錄十、聖喬治呼吸量表信度測試 89
附錄十一、中文版聖喬治呼吸量表使用同意函 93
圖表目錄
圖目錄
圖一、正常呼吸波型 10
圖二、肺量計測量用力肺活量波型 11
圖三、運動時呼吸波型變化 12
圖四、研究概念架構 27
圖五、研究設計圖 28
圖六、研究對象流程圖 30
圖七、資料收集流程圖 38
表目錄
表一、研究對象基本屬性與呼吸系統疾病史特性 42
表二、研究對象肺功能、活動耐受度、生活品質前測之比較 44
表三、兩組肺功能前後測之比較 46
表四、兩組肺功能前後測差之比較 46
表五、兩組組活動耐受度前後測之比較 48
表六、兩組活動耐受度前後測差之比較 48
表七、兩組生活品質前後測之比較 50
表八、兩組生活品質前後測差之比較 50
表九、兩組BODE index前後測之比較 51
表十、兩組BODE index前後測差之比較 51
表十一、組別及每日抽菸包數對肺功能成效之影響 52
表十二、組別及每日抽菸包數對活動耐受度成效之影響 53
表十三、組別及每日抽菸包數對生活品質成效之影響 54
表十四、組別及每日抽菸包數對BODE index成效之影響 55



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