臺灣博碩士論文加值系統

在醫療院所中，呼吸衰竭的患者有日漸增多的趨勢，這是因為醫療技術的進步、對呼吸生理的日漸了解，還有呼吸照護病房的成立，使得呼吸衰竭的患者可以得到機械式的通氣輔助。但是有百分之二十到二十五的患者會難以脫離呼吸器，也就是使用呼吸器超過七天，無法順利脫離，而依賴呼吸器超過二十一天的約有百分之七。這會造成大量的醫療成本消耗，且因長期使用呼吸器，使呼吸道感染增加而導致高死亡率。由於有相同呼吸衰竭的其他疾病，如慢性肺阻塞性疾病、神經肌肉疾病與脊椎損傷患者，使用呼吸肌訓練儀來強化呼吸肌的肌力與耐力後，有減輕呼吸窘迫、增加運動能力及減少感染率的效果。本研究的目的是在探討呼吸肌訓練儀對依賴呼吸器之住院患者的效果。研究方法：將使用呼吸器超過二十一天的氣切患者納入本研究，採隨機分配，分成控制組與訓練組，每組各二十名。兩組接受相同之脫離呼吸器計劃，訓練組的患者另接受呼吸肌訓練儀的呼吸肌訓練：每週五天，每天兩次，每天訓練時間總和最少五分鐘，最多不超過三十分鐘，訓練強度為最大吸氣壓的百分之三十，訓練時期為六週；六週後兩組均接受最大吸氣壓、呼吸肌耐力、使用呼吸器的天數、兩手握力值及脫離呼吸器的成功率之評量。本研究用獨立 t-test來檢定兩組在最大吸氣壓、呼吸肌耐力、使用呼吸器的時間、潮氣量、呼吸次數、快淺呼吸指數及手握力數值是否有統計上的差異，並以存活分析來檢驗兩組脫離呼吸器的成功率是否有統計上的差異。結果：經過六週訓練之後，訓練組之最大吸氣壓從-24.9 cmH2O進步至 -35.6 cmH2O，吸氣肌耐力時間從133.2 sec進步至230.6 sec，與控制組相較，具明顯的進步；呼吸次數從29.8/min減至 24.2/min，快淺呼吸指數從 128.5/min/L下降至 93.7/min/L，均有改善的趨勢，但沒有統計上的意義；二組在脫離呼吸器的成功率以及使用呼吸器的天數無明顯差異。在研究期間訓練組的感染率比控制組減少百分之五十以上，但仍不具統計意義。在研究結束後，二組重插管的比率亦無差異，重插管天數則是訓練組低於控制組，但仍無統計上的差異。結論：依賴呼吸器的患者之吸氣肌是可以被訓練的，接受吸氣肌訓練可以增強其吸氣肌力與耐力，未有充分證據顯示會造成傷害，或可以減少感染及成功脫離呼吸器的機率。吸氣肌力與耐力的增強，可能不是提高脫離呼吸器成功率的最主要因素。

目錄 …………………………………………………………………………1
圖表目錄 ……………………………………………………………………3
摘要 …………………………………………………………………………………5
第一章 前言 ……………………………………………………………………..9
第一節 研究背景 ……………………………………………………………9
第二節 研究目的 …………………………………………………………...12
第三節 研究假說 …………………………………………………………..12
第二章 文獻回顧 ……………………………………………………………….14
第一節 呼吸衰竭的原因 …………………………………………………..14
第二節 吸氣肌疲乏 ………………………………………………………..15
第三節 呼吸肌的測試與訓練 ……………………………………………...17
第四節 呼吸肌訓練的效果 ………………………………………………..19
一. 慢性肺阻塞性疾病患者 ……………………………………………..19
二. 肌肉疾病患者 ………………………………………………………..20
三. 頸部脊椎損傷患者 ………………………………………………….23
四. 呼吸器依賴患者 …………………………………………………….24
第五節 疾病嚴重度評估系統 ……………………………………………….26
第三章 方法與程序 ……………………………………………………………...28
第一節 受測者 ……………………………………………………………...28
第二節 研究流程 …………………………………………………………...29
第三節 訓練計劃 …………………………………………………………...31
第四節 測量工具 …………………………………………………………...32
第五節 統計分析 …………………………………………………………...34
第四章 結果 ……………………………………………………………………..36
第五章 討論 ……………………………………………………………………...46
第六章 結論 ……………………………………………………………………..60
參考文獻 …………………………………………………………………………..61
表 ………………………………………………………………………………….65
圖 ………………………………………………………………………………….82
附錄 ………………………………………………………………………………100
附件 ………………………………………………………………………………102
附件一 國立台灣大學醫學院附設醫院臨床試驗受試者說明及同意書 …….102
附件二 國立台灣大學醫學院附設醫院臨床試驗申請書 …………………….105
附件三 研究結果記錄表 ………………………………………………………...109
附件四 訓練組每日訓練結果記錄表 …………………………………………...110

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