一位肺葉切除術後病患執行肺部復健運動之成效探討

A Case Study of the Effects of Pulmonary Rehabilitation Program after Lung Lobectomy

本個案研究的目的為驗證一套肺葉切除術後患者之肺部復健運動計劃的成效及執行過程中之困難。對象為53歲，女性，因肺癌於南部某醫學中心行右下肺葉切除術。筆者根據文獻查證及相關專家之審查所設計之肺部復健運動計劃包含：上肢運動、下肢運動及呼吸肌運動，且分三階段實施：術前、術後住院與出院階段。生理成效方面顯示，個案術後在週邊血氧濃度(SPO2)及Coach的最大吸氣量皆穩定進步，至術後一個月的最大吸氣量甚至超過術前的數值。手術後一週的六分鐘行走距離（378.2公尺），比術前下降32.3%，但術後一個月後比術前增加24.8%。個案除術後第一及第二天執行運動訓練時需較多次的休息外，均能堅持完成每次的復健運動訓練。心裡方面，由於護理人員復健運動指導之介入，加上家人從旁予以鼓勵，病患在治療期間能維持極高的配合動力。手術後約14天即可獨立執行日常生活活動，返家14天後即已恢復以往正常之社交生活。經設計的復健運動計劃，不但能提供個案生理功能的改善，同時讓病患及其家屬找到共同努力的方向與希望，值得臨床護理人員參考使用。

This case study reported the effects of a pulmonary rehabilitation program for a patient underwent lung lobectomy. In addition, the difficulties of carrying out this program were also examined. The subject was a 53-year-old, female, lung cancer patient, having right lung lobectomy in one of the medical centers at southern Taiwan. Based on literature review and experts’ opinions, the author designed the program. The program includes three types of physical exercise: upper limb, lower limb and respiratory muscle exercise. To carry out this program, three stages were conducted: pre-operation, post-operation and after discharge. The results showed that, physically, the maximum inspiration volume of Coach and SPO2 of the patient consistently improved after surgery. One month after operation, the maximum inspiration volume of Coach was even higher than the amount before surgery. One week after operation, the six minutes walking distance was 32.3% less than the distance before operation, while one month later, the walking distance improved 24.8% comparing to that before surgery. Psychologically, during the process, the nurse and the family was involved intensively when the patient was highly motivated and adhered to the program. Two weeks after the surgery the patient regained her independence in all the activity of daily living. Fourteen days after discharge, the patient was able to perform her regular social activities. The pulmonary rehabilitation program conducted in this study showed not only it improved the physical function of the patient, but also provided the patient as well as her families a goal that they are able to accomplish. This program may provide the clinical nurses useful information to improve their quality of care for the lung lobectomy patients.