復健運用於長期呼吸器依賴病人之成效

Effectiveness of Rehabilitation on Patients with Prolonged Use of Mechanical Ventilation

多數使用呼吸器的病人因為長期的臥床，使得活動量減少與肌力的減退，造成病人需要長期的臥床而影響日常生活功能，更需要家人及醫護人員的從旁照顧。本研究係針對使用呼吸器的病人導入復健運動訓練，藉復健運動期以能增強病人的自我照護的能力，促進良好的生活功能和品質。本研究對象以入住呼吸照護中心∕呼吸照護病房的病人，意識清醒達3天以上且使用呼吸器的病人共22位。給予病人持續八週的復健運動訓練，包括上、下肢肢體運動、呼吸肌訓練、腹式呼吸、有效咳痰等技巧，進而坐、站、走等訓練。並以四肢肌力計分表和功能獨立自主量表為評估工具，分別在復健運動訓練的前後予以量測。研究結果顯示病人在接受復健運動後，四肢肌力的表現均有顯著的提昇；在功能獨立自主量表的評核顯示，動作領域皆有顯著的進步，認知領域方面的溝通能力及社會認知能力也皆有顯著的進步。在22位的呼吸器病人當中，已有9位個案從呼吸照護中心成功的脫離呼吸器並轉至普通病房；1位個案從呼吸照護病房成功的脫離呼吸器並轉至普通病房，2位個案使用簡易型呼吸器回居家照顧。醫院的呼吸醫護團隊應提供相關的復健運動於呼吸器病人，藉以增加肌力和提升自主獨立能力與生活功能。

Patients on mechanical ventilation are often bed-ridden and have difficulty in daily activities due to reduction in physical activity and muscle strength. Therefore, this study was aimed to examine the effectiveness of rehabilitative exercise on these patients. Twenty-two patients who had been hospitalized for over three days with clear consciousness were selected. The patients were provided eight weeks of rehabilitation exercise training, including muscle training of the lower and upper limbs, respiratory muscle training, breath exercise training, and effective coughing up of phlegm training. Furthermore, sitting-up, standing up and walking training were also provided. Before and after the training, patients were measured their muscle strength and the Functional Independent Measure (FIM) assessment. The results showed that after rehabilitation training, there were significant improvements in the muscle strength and daily activities. Progress was detected in the motor and cognitive functions, social interaction and problem solving ability. As for the weaning of ventilators, 10 patients (45.45%) were successfully weaned, 2 (9.10%) were converted to wearing a simple ventilator and could be cared for at home after rehabilitation. This study has shown that rehabilitation exercise could improve the muscle strength and increase functional independence among patients with prolonged use of mechanical ventilation. Respiratory care teams should provide rehabilitation training for those patients.