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研究生：	黃郁婷 Huang, Yu-Ting
論文名稱：	術前介入吸氣肌肉訓練在上腹部手術患者之效果探討 The effects of preoperative inspiratory muscle training in patients with upper abdominal surgery
指導教授：	蔡昆霖 Tsai, Kung-Ling
學位類別：	碩士 Master
系所名稱：	醫學院 - 物理治療學系 Department of Physical Therapy
論文出版年：	2020
畢業學年度：	108
語文別：	英文
論文頁數：	54
中文關鍵詞：	上腹部手術、吸氣肌肉訓練、心肺功能、橫膈膜超音波、術後肺部合併症
外文關鍵詞：	Upper abdominal surgery, Inspiratory muscle training, Cardiopulmonary function, Diaphragm ultrasonography, Postoperative pulmonary complications
相關次數：	點閱：157 下載：0
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背景
接受上腹部手術治療計畫的患者，因長時間的手術麻醉及術後傷口疼痛導致呼吸肌功能降低和黏膜纖毛清除能力下降，甚者可能影響橫膈膜功能而導致術後肺部併發症的發生。術後肺部併發症引起的不良臨床反應包括:死亡率、住院時間及使用呼吸器時間增加等等，皆會使生活品質下降及醫療費用增加。過去研究指出吸氣肌肉訓練閾值阻力器是一種有效改善呼吸肌力量和耐力的訓練方式，並對於心臟及胸腔手術的患者可有效降低術後肺部合併症之發生率。然而，目前仍尚未有直接的研究顯示在上腹部手術病患中介入吸氣肌肉訓練的詳細探討。本研究目的為探討延長訓練時間，從手術前至手術後持續介入吸氣肌訓練之心肺功能變化、橫膈膜活動度、術後肺部合併症和生活品質等相關成效。
方法
本研究收入13位接受上腹部手術的患者將其隨機分配至控制組及吸氣肌訓練組，吸氣肌訓練組從手術前即接受至少兩週的吸氣肌訓練(以50%的最大吸氣壓力作為起始訓練強度，每週增加5-10% MIP的強度)，每天兩次每週五天並持續至手術後，控制組則接受常規衛教。研究探討訓練前後之呼吸肌力、橫膈膜活動度、心肺功能及術後肺部合併症之成效，研究數據進行組間及組內之比較。
結果
在我們的研究中，發現吸氣肌訓練組經過手術前至手術後完整的吸氣肌訓練，在手術後及出院後一週的測量，其橫膈膜活動度、心肺適能之血壓和運動自覺強度反應和生活品質比起第一次測量數值有達到顯著差異。雖然控制組和訓練組兩組之間的比較沒有達到顯著差異，但控制組並無優異的情形，甚至數據有變差的趨勢。
結論
在本篇研究中，發現在上腹部手術患者接受吸氣肌肉訓練可增強橫膈膜活動度及生活品質表現，是個有效的物理治療運動。

Background
Patients who accepted the upper abdominal surgical treatment may have the reduced respiratory muscle function and mucociliary clearance due to the long periods of anesthesia and pain. These adverse complications may result in the increased length of hospital stay, longer use of ventilators and mortality, leading to higher medical costs. Previous research has shown that the threshold inspiratory muscle training may serve as an effective modality to improve respiratory muscle strength and endurance for cardiac and thoracic surgery patients. However, whether these training could help patients with upper abdominal surgery remain to be determined. Hence, the purpose of this study is to investigate the effect of extending training time with inspiratory muscle training.
Methods
In this study, 13 patients who underwent upper abdominal surgery were randomly assigned to the control group and the inspiratory muscle training (IMT) group. The control group received regular health care. On the other hand, the IMT group received at least two weeks of IMT training with 50% of MIP as the initial training intensity. The intensity of MIP increased by 5-10% per week until the operation day, twice a day, five days a week. The study investigated the effects on respiratory muscle strength, diaphragmatic activity, cardiopulmonary function and postoperative pulmonary complications. To compare those data between groups and intra-group before and after training.
Results
We found that the diaphragmatic excursion, blood pressure response of cardiopulmonary fitness and quality of life show significant benefits in the patients who were postoperative and after discharged for one week than baseline in inspiratory muscle training group. Although we did not find a significant difference of results between the control group and IMT group, but the diaphragmatic excursion, blood pressure and RPE response of cardiopulmonary fitness and quality of life had a tendency to deteriorate apparently in the control group.
Conclusions
In our study, inspiratory muscle training in upper abdominal surgery patients was found to be effective in enhancing diaphragmatic excursion and quality of life. Consequently, it can be an effective physical therapy exercise.

摘要	I
ENGLISH ABSTRACT	III
ACKNOWLEDGEMENT	V
ABBREVIATION	VI
CHAPTER I INTRODUCTION	1
I. 1 Respiratory physiology undergoing upper abdominal surgery	1
I. 2 Postoperative pulmonary complications of upper abdominal surgery	1
I. 3 Physiotherapy of prehabilitation	2
I. 4 Inspiratory muscle training in surgery	3
I. 4. 1 Respiratory muscle strength and PPCs	3
I. 4. 2 Pulmonary function test	4
I. 4. 3 Diaphragm ultrasonography	4
I. 5 Purpose of the study	5
CHAPTER II MATERIALS AND METHODS	6
II. 1 Study design	6
II. 2 Study participants	6
II. 3 Procedures	6
II. 4 Study protocol	7
II. 5 Assessment	7
II. 5.1 Respiratory muscles strength	7
II. 5.2 Pulmonary function test	8
II. 5.3 Diaphragm ultrasonography	9
II. 5.4 Cardiorespiratory fitness (3-min step test)	10
II. 5.5 Postoperative Pulmonary complications rate (PPCs rate)	11
II. 5.6 Quality of life (SF-36 scale)	11
II. 6 Outcomes measurements	12
II. 7 Statistical analysis	12
CHAPTER III RESULTS	13
III. 1 Demographic and clinical characteristics	13
III. 2 Respiratory muscle strength	13
III. 3 Pulmonary function test	14
III. 4. Diaphragm ultrasonography	14
III. 5. Cardiorespiratory fitness (3-min step test)	15
III. 6. Postoperative Pulmonary complications rate (PPCs rate) and length of hospitalization	17
III. 7. Quality of life (SF-36 scale)	17
CHAPTER IV DISCUSSION	18
IV. 1 IMT training can enhance respiratory muscle strength	19
IV. 2 IMT intervention is insufficient improve pulmonary function test	19
IV. 3 IMT intervention can enhance diaphragm motion on ultrasonography	20
IV. 4 Threshold IMT was an effective strategy on cardiorespiratory fitness (3-min step test)	21
IV. 5 IMT intervention is insufficient to improve postoperative pulmonary complications rate (PPCs rate) and length of hospitalization between groups	22
IV. 6 IMT intervention improved the physiological function on quality of life (SF-36 scale)	23
CHAPTER V CONCLUSIONS	24
CHAPTER VI REFERENCES	25
TABLES	29
Table 1. Demographic and clinical characteristics of control group and IMT group	29
Table 2. Respiratory muscle strength of control group and IMT group	30
Table 3. Pulmonary function test of control group and IMT group	31
Table 4. Diaphragm ultrasonography measurements of control group and IMT group	32
Table 5. 3-min step test of control group and IMT group (Blood pressure response)	33
Table 6. 3-min step test of control group and IMT group (Heart rate response)	34
Table 7. 3-min step test of control group and IMT group (SpO2 and RPE response)	35
Table 8. Short Form-36 (SF-36) scores of control group and IMT group	36
FIGURES	37
Figure 1. Study flow chart	37
Figure 2. Respiratory muscle strength: MIP of control group and IMT group	38
Figure 3. Respiratory muscle strength: MEP of control group and IMT group	39
Figure 4. Pulmonary function test: FEV1 of control group and IMT group	40
Figure 5. Pulmonary function test: FVC of control group and IMT group	41
Figure 6. Pulmonary function test: FEV1/FVC of control group and IMT group	42
Figure 7. Diaphragm ultrasonography: diaphragmatic excursion of control group and IMT group	43
Figure 8. Inspiratory muscle training threshold trainer (DofinTM, Breathing Strength Builder, Taiwan)	44
Figure 9. Ultrasound machine (ACUSON NX3 Elite, Siemens Healthineers, Germany)	44
Figure 10. Respiratory pressure meter (GB60, JITTO, Taiwan)	45
Figure 11. Spirometry (microQuark, COSMED, Italy)	45
Figure 12. RPE 6-20 scale	46
Figure 13. SF-36 quality of life questionnaire part 1	47
Figure 14. SF-36 quality of life questionnaire part 2	48
Figure 15. SF-36 quality of life questionnaire part 3	49
Figure 16. SF-36 quality of life questionnaire part 4	50
Figure 17. SF-36 quality of life questionnaire part 5	51
Appendix	52
Appendix 1. Certification of human study approval	52
Appendix 2. Image of diaphragm ultrasonography (diaphragm excursion)	53
Appendix 3. Image of diaphragm ultrasonography (diaphragm thickening fraction)	53
Appendix 4. Definition of postoperative pulmonary complications on European Perioperative Clinical Outcome 2015	54


                                    

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