誘發性深呼吸器於手術病人之運用

The Use of Incentive Spirometer to Perioperative Patients

肺擴張不全是手術後最常見之肺合併症之一，其基本機轉為缺乏充氣，主因為術後傷口痛或牽扯痛致呼吸淺快無間歇性深呼吸。研究顯示若一小時內無法完全擴張肺，將產生微小肺擴張不全，持續數小時後即演變成巨大肺擴張不全。其預防或治療方法為過度充氣治療，而誘發性深呼吸為其中一種方式，乃藉由誘發性深呼吸器來鼓勵病人作深呼吸運動，而誘發性深呼吸器是利用浮標的升起或燈光閃爍來顯示吸入空氣的最大量或流速，病人能直接看到自己的成績，進而藉此視覺回餚激勵病人自己作深呼吸的設置。其效果和同為過度充氣治療之自主性深呼吸與間歇性陽壓呼吸相當；對於高危險群病患，更優於胸部物理治療。其有增加肺順應性、減少呼吸功、增加動脈氧合、增進痰液排出、縮短住院日數、訓練呼吸肌之功效。其需注意之呼吸技巧有慢慢的吸氣、深吸氣、摒息2-3秒、慢且鬆弛的吐氣、每小時作5-10次。若能善加利用，在預防手術後肺合併症上，必是一好幫手。

Atelectasis is the major postoperative pulmonary complication. The cause is no intermittent deep breathing due to operative wound pain. The prevention and treatment is hyperinflation therapy. Incentive spirometry is one kind of hyperinflation therapy. The method of incentive spirometry is using incentive spirometer to reinforce the patient to do deep breathing. Incentive spirometer has the buoy or light to show the volume or the flow of deep breathing. The patient can see his effort, then he is stimulated to do it by the feedback. It has the same effect as voluntary deep breathing and IPPB, and has better effect than chest physiotherapy for the high risk patients. It can increase lung compliance, decrease breathing work, increase arterial oxygenation, increase excreting sputum, shorten the hospital days, and train the respiratory muscles. The operating skills of incentive spirometry include slow inspiration, deep inspiration, breath hold for 2-3 seconds, slow relaxed exhalation, and 5-10 times every hour. If the nurse can use it very well, it must be a good assist for the prevention of pstoperative pulmonary complication.