不同臥位對肝硬化腹水病人之血氧飽和度、舒適度與呼吸困難程度之影響

Effects of Head Posture on Oxygenation Saturation, Comfort, and Dyspnea in Patients with Liver Cirrhosis-Related Ascites

背景：肝硬化合併腹水對患者影響是多面的，一旦合併症引發呼吸困難或其他不適情形，病人生活品質會大受影響，在生理、心理與社會各層面皆出現負面的衝擊。目的：探討不同床頭抬高臥位對肝硬化腹水病人之血氧飽和度、舒適度與呼吸困難程度之影響。方法：採類實驗性研究設計，以方便取樣，招募台灣北部某醫學中心之胃腸肝膽科病房252位肝硬化病人為研究對象。依照研究設計監測研究對象在床頭抬高15度、30度及45度等三種不同角度臥位的血氧飽和度、舒適度與呼吸困難程度，所得的測量值進行推論性統計分析。結果：（1）在血氧值方面，病人在三種不同角度臥位中不具統計意義；三組角度在時間改變於調整角度5分鐘後測量統計上有顯著差異（p＜.01），病人血氧值在15度臥位時較45度時高；（2）在舒適程度方面，病人在三種不同角度臥位中不具統計意義；（3）在呼吸困難程度方面，病人在三種不同角度臥位中，於45度臥位時較15度時呼吸困難（p＜.05）。因此，腹水病人在15度臥位時比30度及45度臥位時更能獲得較佳血氧飽和度，且較不會有呼吸困難的感覺。結論／實務應用：研究結果可作為照護腹水病人，改變臥位時的參考，在考量病情下，提供適當適切的臥位及調整床頭角度，使病人氧合及舒適程度更趨於穩定狀態，減少合併症的發生。

Background: Chronic liver disease and cirrhosis are collectively ranked as the ninth most prevalent cause of death in Taiwan. Ascites is the most common comorbidity associated with liver cirrhosis. Different body postures affect pulmonary ventilation and arterial oxygen partial pressure. Thus, ensuring proper body posture in patients is an important clinical nursing intervention that significantly affects the recovery of patients. Purpose: This study investigates the effects of head posture on oxygenation saturation, comfort, and dyspnea in patients with liver cirrhosis-related ascites. Methods: A quasi-experimental study design was used. A total of 252 participants were recruited from a medical centre hospital in Taiwan. Participants were allocated randomly into three groups of bed-elevation angles: 15 degrees, 30 degrees, and 45 degrees. The physiological indices were measured at 5, 10, 15, 20, 25, and 30 minutes in order to investigate the change in oxygenation saturations that were attributable to the different angles. Data were analyzed using descriptive statistics. The generalized estimating equation (GEE) was used for statistical analysis, with the level of significance set at: α = .05. Results: After controlling for confounding variables, the results showed that patients in the three groups earned similar scores for the degree of difficulty in the oxygen values. The supine group earned significantly different scores than the other two groups in terms of blood oxygen values related to time to change the angle of the three groups at five minutes after adjusting the angle (p＜.01). This study found no differences among the three groups in terms of comfort. In terms of breathing, this sudy found a significant difference between 45-degree and 15-degree supine dyspnea(p＜.05). Therefore, patients with ascites at 15 degrees supine and with better access to better oxygen saturation had superior results to their peers at 30 degrees and 45 degrees supine. Furthermore, this group was less likely to perceive breathing difficulties. Conclusions / Implications for Practice: The results of this study may guide health education and care for nurses in order to improve the quality of care for patients with chronic liver disease / cirrhosis with concomitant ascites.