臺灣博碩士論文加值系統

研究背景與目的:重症肌無力（Myasthenia Gravis, MG）是神經肌肉突觸的自身免疫性疾病，其臨床表徵在於侵犯骨骼肌：如眼球、延髓、肢體和呼吸肌，嚴重時甚至會威脅性命。而患者呈現的“肌無力模式”，因呼吸肌受到影響，表現為運動耐受量下降，呼吸困難；換言之維持增加通氣的能力也隨之降低，最大自主性通氣量（MVV）隨之減少及降低呼吸肌耐力，因此呼吸肌功能改善是重症肌無力治療中的重要目標。許多關於呼吸肌訓練的研究也相繼出現，且對呼吸肌強化，對改善呼吸困難及預防或緩解通氣障礙及疲勞的產生頗具成效。故本研究目的在於探討重症肌無力患者執行居家吸氣肌訓練之成效。
研究方法:採臨床隨機控制試驗實驗設計，共收案21位重症肌無力第二期的病人為對象，控制組接受一般常規治療，研究組除一般常規治療外，另接受12週之居家吸氣肌訓練。並追蹤前後的肺功能，呼吸肌力；運動能力及生活品質之成效。
研究結果:前後測數值比較，研究組在肺功能的用力肺活量(FVC)：
2.67 ± 0.9 vs.3.24 ± 0.8L，第一秒呼氣容積(FEV1)：2.09 ± 0.6 vs.2.72 ± 0.7L/min，尖峰呼氣流速(PEF)：5.52 ± 1.8 vs.5.90 ± 1.8 L/min，最大呼氣中段流量25-75%（MMEF25-75%）：2.12 ± 1.1vs.2.33 ± 1.1，最大吸氣壓(MIP)：66.82 ± 33.5 vs.94.55 ± 42.5 cmH2O，最大吐氣壓(MEP)：76.55 ± 22.6 vs.93.82 ± 21.9 cmH2O，六分鐘行走距離(6MWD)：387.18 ± 83.6 vs.423.86 ± 90.8公尺，及短型多軸向疲倦測量分數（MFSI-SF-C）：36.36 ±11.06 vs.30.18 ±11.38皆有顯著改善(p < 0.05)，而控制組則無顯著變化。而生活品質與肺功能、呼吸肌力、運動能力及改良式柏格量表分數則無相關性(p > 0.05)，但生活品質總分則與尖峰呼氣流速、貝克憂鬱量表分數及短型多軸向疲倦測量表分數呈現統計顯著相關 (p < 0.05)。
結論:居家吸氣肌訓練運動可改善肺功能、呼吸肌力、運動能力與生活品質之疲倦層面，而肺功能之尖峰呼氣流速指標也與生活品質有顯著相關，故建議重症肌無力患者提早執行居家吸氣肌訓練治療，可提升生理及心理功能。本研究結果可作為臨床照護之參考依據。

Background and purpose: Myasthenia Gravis (MG) is an autoimmune disease of the neuromuscular synapses. Its clinical manifestation is the invasion of the skeletal muscle: the eyeball, the medulla, the limbs and the respiratory muscles, which may even threaten the life of the muscles.
The "myasthenia pattern" presented by the patient is affected by the respiratory muscles, showing a decline in exercise tolerance and difficulty in breathing; in other words, the ability to maintain increased ventilation is also reduced, and the maximum voluntary ventilation (MVV) decreases and reduces the respiratory muscle endurance. Therefore, the improvement of respiratory muscle function is the treatment of myasthenia gravis important goals.
Many studies on respiratory muscle training have emerged, and the enhancement of respiratory muscles is effective in improving respiratory difficulty and preventing or alleviating aeration disorders and fatigue. The aim of this study was to explore the effectiveness of home breathing exercises in myasthenia gravis patients.
Methods: A randomized controlled trial was designed for 21 patients with stage second of myasthenia gravis. The control group received general routine treatment, and the study group received 12 weeks of home respiratory muscle training except general routine treatment. The effects of lung function, respiratory muscle strength, exercise ability and quality of
Life were traced.
Results: Comparison of pre and post measurements of forced vital capacity (FVC) in the lung function of the study group :2.67 ± 0.9 vs. 3.24 ± 0.8L, forced expiratory volume in 1 second (FEV1): 2.09 ± 0.6 vs. 2.72± 0.7 L / min, peak expiratory flow (PEF): 5.52± 1.8 vs. 5.90 ± 1.8 L / min, maximum mid-expiratory flow 25-75% (MMEF 25-75%): 2.12 ± 1.1 vs. 2.33 ± 1.1, maximal inspiratory pressure (MIP): 66.82 ± 33.5 vs. 94.55 ± 42.5 cmH2O, maximal expiratory pressure (MEP): 76.55 ± 22.6 vs. 93.82 ± 21.9 cmH2O), 6-minute walking distance (6MWD): 387.18 ± 83.6 vs. 423.86 ± 90.8 m, and multidimentional Fatigue Symptom Inventory-Short Form (MFSI-SF-C):36.36±11.06 vs.30.18±11.38 all improved significantly (p < 0.05), but there was no significant change in the control group. However, there was no correlation between quality of life and pulmonary function, respiratory muscle strength, exercise ability and Modified Borg Scale score (p > 0.05), but quality of life score was significantly correlated with peak expiratory flow,Beck Depression inventory scale score and multidimentional Fatigue Symptom Inventory-Short Form scale score (p < 0.05).
Conclusion: Conclusion: Home inspiratory muscle training can improve lung function, respiratory muscle strength, exercise ability and quality of life fatigue level, and peak expiratory flow index of lung function is also significantly related to the quality of life. Therefore, it is recommended that patients with myasthenia gravis should carry out home inspiratory muscle training early to improve their physiological and psychological functions. The results of this study can be used as a reference for clinical care.

中文摘要 IV
Abstract VI
圖目錄 XI
表目錄 XII
第一章 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 研究假設 4
第五節 名詞定義 4
第二章 文獻探討 8
第一節 重症肌無力 8
第二節 呼吸肌訓練 17
第三節 生活品質 33
第三章 研究方法 40
第一節 研究設計 40
第二節 研究架構 41
第三節 研究場所與對象 42
第四節 研究工具 43
第五節 統計及分析 49
第六節 研究倫理考量 51
第四章 研究結果 52
第一節 研究對象基本屬性 52
第二節 吸氣肌訓練介入對肺功能之成效 58
第三節 吸氣肌訓練介入對呼吸肌力之成效 60
第四節 吸氣肌訓練介入對運動能力之成效 61
第五節 吸氣肌訓練介入對生活品質之成效 63
第六節 肺功能、呼吸肌力、運動指標、憂鬱、疲倦和生活品質之關聯性分析 68
第五章 討論 72
第一節 研究對象之基本屬性 72
第二節 吸氣肌訓練對肺功能之成效 73
第三節 吸氣肌訓練對呼吸肌力之成效 75
第四節 吸氣肌訓練對運動能力之成效 77
第五節 吸氣肌訓練對生活品質之成效 78
第六節 肺功能、呼吸肌力、運動能力、焦慮、疲倦與生活品質之關聯 80
第六章 總結 83
第一節 結論 83
第二節 建議 84
第三節 研究限制 85
第四節 未來研究方向 86
參考文獻 88
附錄 93
附錄一 WHOQOL-BREF台灣簡明版 使用授權書 93
附錄二 重症肌無力患者評估問卷 94
附錄三 世界衛生組織生活品質問卷 95
附錄四 貝克憂鬱量表第二版 98
附錄五 短型多軸向疲倦量表中文版 100
圖目錄
圖2- 1致病機轉 11
圖2- 2眼肌型肌無力（OCULAR MYASTHENIA） 15
圖2- 3 吸氣閾值負荷訓練裝置 27
圖3- 1 研究設計 40
圖3- 2 研究架構 41
圖3- 3 肺功能測量儀 43
圖3- 4 NELLCOR OXIMAX N-65 PULSE OXIMETER 44
圖3- 5 壓力測量表 45
圖3- 6 手持呼吸肌訓練器 45
圖3- 7 改良式柏格式量表(MODIFIED BORG SCALE) 49
表目錄
表2- 1 肌無力OSSERMAN臨床分級 12
表2- 2 美國重症肌無力基金會分級（Myasthenia Gravis Foundation of America Clinical Classification) 12
表2- 3重症肌無力治療策略 16
表2- 4 健康人和運動員的呼吸肌訓練效果 22
表2- 5 疾病族群的呼吸肌訓練效果 29
表2- 6 WHOQOL-BREF 台灣版問卷的題目內容 36
表2- 7 重症肌無力相關的生活品質 38
表4- 1 研究對象之基本屬性 55
表4- 2 研究對象肺功能、呼吸肌力、運動能力之比較 56
表4- 3 研究對象生活品質、憂鬱、疲倦量表之比較 57
表4- 4 兩組肺功能前後測之比較 58
表4- 5 兩組肺功能前後測差值之比較 59
表4- 6 兩組呼吸肌力前後測之比較 61
表4- 7 兩組呼吸肌力前後測差值之比較 61
表4- 8 兩組運動能力前後測之比較 62
表4- 9 兩組運動能力前後測差值之比較 63
表4- 10 兩組生活品質問卷各題號之前後測比較 65
表4- 11 兩組生活品質、憂鬱、疲倦量表之前後測比較 66
表4- 12 兩組生活品質、憂鬱、疲倦量表之前後測差值比 67
表4- 13 肺功能、呼吸肌力及運動能力與生活品質相關分析 70
表4- 14 肺功能、呼吸肌力及運動能力與生活品質之生理、心理、社會關係、環境範疇相關分析 71

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