肺部復健運動介入對使用呼吸器重症病患之成效－－系統性文獻回顧

The Effectiveness of Pulmonary Rehabilitation for Critical-Care Ventilator Patients: A Systematic Review

背景：長期使用呼吸器造成吸氣肌肉無力，使得脫離呼吸器更加困難，病患的死亡率與心理壓力也隨之上升，肺部復健的介入對於提升呼吸肌肉力量有一定的成效，但肺部復健運動種類很多，藉由提升吸氣肌肉力量，是否可以提高呼吸器脫離成功率、縮短呼吸器使用時間等成效尚不明確。目的：以系統性文獻回顧方法，探討肺部復健的介入，對於使用呼吸器重症病患於呼吸器脫離率及身體活動功能之成效。方法　以系統性文獻回顧法，使用「mechanical ventilation」、「pulmonary rehabilitation」、「exercise」、「weaning」、「activities of daily living」、「呼吸器」、「肺部復健」、「運動」、「脫離率」等關鍵字搜尋2015年2月前，發表於Cochrane Library、Embase、MEDLINE、PubMed、華藝線上圖書館及臺灣博碩士論文知識加值系統等資料庫，選取使用呼吸器重症病患相關文獻，符合篩選標準並排除重複文獻，共得七篇以肺部復健運動介入之實驗性研究（randomized clinical trial）進行分析與整理。結果　本系統性文獻回顧納入七篇隨機分派之實驗性研究，共382位加護病房或呼吸照護病房使用呼吸器病患。結果發現，肺部復健運動對於提升加護病房使用呼吸器重症病患之呼吸器脫離率及身體活動功能有幫助。但受限於研究樣本數小，且復健運動種類有所不同，結果能否推廣，還需更多研究進行探討。 結論／實務應用　整合文獻結果，使用呼吸器＞48小時病患，肺部復健運動對於提升加護病房使用呼吸器重症病患之呼 吸器脫離率及身體活動功能有幫助，但臨床上部分無法執行上下肢復健運動病患，在血液動力學穩定且已調降至壓力支持模式的情況下，可考慮從吸氣肌肉訓練開始，期能藉此提提升呼吸器脫離率。

Background: Prolonged of use mechanical ventilators results in respiratory muscle atrophy and difficulties in weaning, which increase mortality rates and psychlogical distress. While pulmonary rehabilitation has been shown to improve respiratory muscle strength, the effects of this intervention in critical-care patients who use mechanical ventilation remain uncertain. Purpose: The present paper uses a systematic review of the literature to evaluate the effects of pulmonary rehabilitation on the rate of ventilator weaning and on the physical performance of ventilator patients receiving critical care. Methods: A systematic review was used. Searches were conducted in databases including: Cochrane Library, Embase, MEDLINE, PubMed and Airit Library. Keywords that were used included: ＂mechanical ventilation＂, ＂pulmonary rehabilitation＂, ＂exercise＂, ＂weaning＂, and ＂activities of daily living＂. The search focused on articles that were published prior to February 2015. Based on inclusion and exclusion criteria, 7 articles addressing relevant randomized controlled trials were extracted. Results: All of the 7 studies supported that pulmonary rehabilitation interventions improve mechanical ventilation weaning and functional independence activities. Several studies were limited by small sample size and differences in the types of rehabilitations used. Thus, the generalizability of the findings of this review is limited. and further research is required to verify the effects of pulmonary rehabilitation. Conclusions / Implications for Practice: The results of this systematic review support that pulmonary rehabilitation interventions improved the weaning rate, activities of functional independence, and maximal inspiratory pressure (MIP) in critical patients who had used mechanical ventilators for over 48 hours. Under hemodynamic-stablized and pressure-support mode, inspiratory muscle training is suggested as useful for patients with limited ability to participate in rehabilitation programs.