探討高頻胸壁振盪治療對患者痰液清除之成效

Effects of High-Frequency Chest Wall Oscillation on Sputum Clearance

目的：肺部疾病患者常因痰液滯留體內，導致呼吸道感染而入院治療，傳統治療會執行背部叩擊及震顫等護理措施，但因過程中可能會造成患者的身體不適及血液動力學不穩定等現象，進而影響痰液清除效果，因此如何兼顧舒適安全又有效的清除痰液，以預防呼吸道感染，已成為臨床重要議題。故本研究目的為探討高頻胸壁振盪治療改善肺部疾病患者痰液積存之成效。方法：採兩組前後測之實驗研究設計法，於中部地區某醫學中心胸腔內科病房為研究場所進行收案，將符合研究對象個案數共60人，以隨機分派方式至實驗及對照組，實驗組進行高頻胸壁振盪治療介入，對照組則使用傳統胸腔物理治療。以前後測量之血氧飽和濃度、胸部X-光、舒適度變化，並觀察患者痰液咳出量作為痰液清除成效分析指標。結果：實驗組介入高頻胸壁振盪治療後，患者痰液清除指標中血氧飽和濃度以及舒適情形，實驗組優於對照組，達統計顯著差異p<0.05；另外胸部X-光、痰液咳出量，兩組未達到統計顯著性，p>0.05。結論：不論實驗組或對照組，對於患者胸部X-光改善及痰液咳出情形都是有幫助的，但是顧及臨床上人力之考量及增進患者舒適度，介入高頻胸壁振盪治療則是另一個選擇。

Purposes: Sputum retention often causes respiratory tract infections and hospitalization of patients for pulmonary diseases. Conventional techniques for sputum clearance include percussion (clapping) and vibration. However, these treatments may lead to discomfort and hemodynamic instabilities in patients, thereby influencing the effectiveness of sputum clearance. Thus, developing a safe, comfortable, and effective sputum clearance method that can also prevent respiratory tract infections has become a significant clinical issue. This study intended to investigate the effects of high-frequency chest wall oscillation (HFCWO) on sputum clearance for patients with pulmonary diseases. Methods: A two-group, before-after research design was adopted to investigate the effects of HFCWO on patients from the pulmonary medicine division ward of a medical center in central Taiwan. Based on predefined criteria, 60 patients were included, each randomly assigned to either the HFCWO group (provided with HFCWO therapy) or the control group (provided with the conventional chest physical therapy). As indicators for the analysis of sputum clearance effectiveness, the oxygen saturation level, perceived comfort level, and observed amount of discharged sputum were measured and chest radiography was performed for each patient before and after the experiment. Results: The results showed that the oxygen saturation and perceived comfort levels of the patients in the HFCWO group were significantly improved (p<0.05). However, no apparent differences in chest radiographic results and sputum volume were found between the groups (p>0.05). Conclusions: Both HFCWO and the conventional chest physical therapy improved the patients’ chest radiographic results and sputum clearance. However, considering the limited workforce of nursing staff and the comfort levels of patients, HFCWO can be an effective alternative method for sputum clearance.