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研究生：	游群翔 Yu, Chun-Hsiang
論文名稱：	居家吸氣訓練對於需使用非侵襲性呼吸器患者的成效評估 Evaluation of the effectiveness of home-based inspiratory muscle training on patients requiring non-invasive ventilation
指導教授：	劉立凡 Liu, Li-Fan
學位類別：	碩士 Master
系所名稱：	醫學院 - 公共衛生研究所碩士在職專班 Graduate Institute of Public Health(on the job class)
論文出版年：	2021
畢業學年度：	109
語文別：	中文
論文頁數：	64
中文關鍵詞：	吸氣肌訓練、呼吸器依賴、生活品質
外文關鍵詞：	Inspiratory muscle training, Home ventilator, Quality of life
相關次數：	點閱：70 下載：3
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肺部復原計畫是一項包括病人衛教與運動訓練的計畫，其中運動訓練包括肢體骨骼肌的肌力與耐力訓練，以及呼吸肌的訓練，並增強呼吸道黏液的清除。在慢性阻塞性肺病、慢性心臟病、以及因急性呼吸衰竭而導致呼吸器依賴的患者身上，運動訓練可增加運動耐受性，減少呼吸急促症狀，以及提高急性呼吸衰竭患者脫離呼吸器的機率。但是，針對慢性呼吸衰竭合併呼吸器依賴的患者，運動訓練相關的研究極少，因此缺乏臨床運動訓練相關的實證。此次所進行的研究，是針對已是非侵襲性呼吸器依賴的居家患者，以吸氣阻力閥值負荷的介入方式作為吸氣肌的訓練，了解其對患者的吸氣肌的肌力、呼吸道症狀、以及生活品質的影響。

Pulmonary rehabilitations are the programs including the health education and exercise train for patients. The exercise train consists of the endurance and strength training of the limbs skeletal muscle, respiratory muscle training, and the increasing clearance of airway system mucus. The exercise train of pulmonary rehabilitations could enhance the exercise tolerance and reduce the dyspnea symptoms among the patients with chronic obstructive pulmonary disease or chronic heart failure. And, this training could increase the probability of successful weaning from mechanical ventilator among the patients with ventilator depending due to acute respiratory failure. However, there are less exercise training associated researches for patients with ventilator depending due to chronic respiratory failure. Therefore, the evidence of clinical exercise practices is lacked. This study we had processed aims to explore the effects of the intervention with inspiratory resistant threshold loading for inspiratory muscle training among the patients with home mechanical non-invasive ventilator dependence. In order, we could know the influence from the intervention over the patients’ inspiratory muscle strength, airway symptoms, and the quality of life.

第一章 緒論 ……………………………………………………………1
第一節 研究背景與重要性 ……………………………………………… 1
第二節 研究動機 ……………………………………………………… 2
第三節 研究目的、研究問題、與研究假設 ………………………………… 2
第四節 研究效益 ………………………………………………………3
第二章 文獻查證 ……………………………………………………… 4
第一節 呼吸器脫離的概念 ……………………………………………… 4
第二節 脫離呼吸器成功與失敗 …………………………………………… 5
第三節 使用呼吸器患者的分類 …………………………………………… 6
第四節 困難脫離呼吸器的病態生理 ………………………………………… 6
第五節 肺部復健與呼吸肌訓練 …………………………………………… 7
第六節 呼吸肌訓練的成效 ………………………………………………… 9
第三章 研究方法 ………………………………………………………… 10
第一節 研究架構 …………………………………………………………10
第二節 研究設計與研究流程 ……………………………………………… 11
第三節 研究對象、場所與樣本數 ………………………………………… 12
第四節 研究工具與信效度檢定 …………………………………………… 13
第五節 統計分析方法 …………………………………………………… 17
第六節 研究對象之權益保護 ………………………………………………17
第七節 研究預期進度及研究限制 ……………………………………………18
第四章 研究結果 ……………………………………………………18
第一節 居家呼吸器依賴患者基本資料統計 ………………………………18
第二節 符合收案患者基本資料統計 ……………………………………23
第三節 吸氣肌訓練介入之後與停止介入後的比較 …………………………25
第四節 次族群的分層分析 …………………………………………… 27
第五章 討論 ……………………………………………………………49
第六章 結論與建議 ……………………………………………………54
第一節 結論 …………………………………………………………54
第二節 研究限制 …………………………………………………… 54
第三節 應用與建議 ……………………………………………………55
參考文獻 ………………………………………………………………56 
附錄一 歐洲健康八项生活質量调查表歐洲健康八项生活質量调查表（（EUROHIS-QOL 8）） 
附錄二 歐洲五維健康量表歐洲五維健康量表 ( EQ-5D-5L )
附錄三 呼吸困難評估量表呼吸困難評估量表 (Modified Medical Research Council, mMRC )以及慢性阻塞性肺病評估量以及慢性阻塞性肺病評估量表 ( COPD assessment test, CAT)
附錄四 工具性日常生活活動能力量表 (Instrumental activities of daily living, IADL)
附錄五 日常生活活動日常生活活動量量表表(Activities of daily living, ADL) 
附錄六 迷你營養評估量表迷你營養評估量表（Mini Nutritional Assessment, MNA）

Table contents
Table 1 納入收案之個案基本資料納入收案之個案基本資料 ………………………………………………………………24
Table 2 受試者各時間點預後測量數值變化受試者各時間點預後測量數值變化 ……………………………………………………26
Table 3 受試者中阻塞性肺病受試者中阻塞性肺病(COPD)(COPD)與非阻塞性肺病與非阻塞性肺病(non COPD)(non COPD)各時間點預後測量數值變化各時間點預後測量數值變化…27
Table 4 受試者中年齡分層受試者中年齡分層各時間點預後測量數值各時間點預後測量數值 ……………………………………………31
Table 5 受試者依照受試者依照日常生活活動日常生活活動量量表表(ADL)(ADL)分層分析分層分析各時間點預後測量數值變化各時間點預後測量數值變化 …………35
Table 6 受試者依照受試者依照工具性日常生活活動工具性日常生活活動量量表表(IADL)(IADL)分層分析分層分析各時間點預後測量數值變化各時間點預後測量數值變化 …38
Table 7 受試者依照受試者依照身體質量指身體質量指數數(BMI)(BMI)分層分析分層分析各時間點預後測量數值變化各時間點預後測量數值變化 ………………41
Table 8 針對預後中呼吸道症狀針對預後中呼吸道症狀mMRCmMRC量表，做各變項之單變量與多變量分析量表，做各變項之單變量與多變量分析 ……………44
Table 9 針對預後中呼吸道症狀針對預後中呼吸道症狀CATCAT量表，做各變項之單變量與多變量分析量表，做各變項之單變量與多變量分析 …………………45
Table 10 針對預後中呼吸道生理測量最大吸氣壓針對預後中呼吸道生理測量最大吸氣壓(MIP)(MIP)，做各變項之單變量與多變量分，做各變項之單變量與多變量分析析……45
Table 11 針對預後中呼吸道生理測量最大吐氣壓針對預後中呼吸道生理測量最大吐氣壓(MEP)(MEP)，做各變項之單變量與多變量分析，做各變項之單變量與多變量分析 …46
Table 12 針對預後中呼吸道生理測量針對預後中呼吸道生理測量尖峰流速率（尖峰流速率（PPEFREFR）），做各變項之單變量與多變量分析，做各變項之單變量與多變量分析......47
Table 13 針對預後中針對預後中生活品質的問卷量表（生活品質的問卷量表（EUROHISEUROHIS--88）），做各變項之單變量與多變量分析，做各變項之單變量與多變量分析 ...48
Table 14 針對預後中針對預後中生活品質的問卷量表（生活品質的問卷量表（EQ5DEQ5D）），做各變項之單變量與多變量分析，做各變項之單變量與多變量分析 ………49

Figure contents
Figure 1. 研究架構研究架構………………………………………………………………11
Figure 2. 研究設計與流程研究設計與流程 ………………………………………………………12
Figure 3. 受試者收案流程受試者收案流程 ………………………………………………………13
Figure 4. 受試者手持式吸氣肌訓練器受試者手持式吸氣肌訓練器 ……………………………………………17
Figure 5. 呼吸器依賴個案性別比例呼吸器依賴個案性別比例 ………………………………………………19
Figure 6. 呼吸器依賴個案呼吸器依賴個案年齡分布年齡分布 ………………………………………………19
Figure 7. 呼吸器依賴個案呼吸器依賴個案年齡分布占比年齡分布占比……………………………………………20
Figure 8. 呼吸器依賴個案呼吸器依賴個案呼吸衰竭各主因人數呼吸衰竭各主因人數 ……………………………………20
Figure 9. 呼吸器依賴個案呼吸器依賴個案呼吸衰竭各主因占比呼吸衰竭各主因占比 ……………………………………21
Figure 10. 呼吸器依賴個案呼吸器依賴個案主要照顧者身分主要照顧者身分 ………………………………………21
Figure 11. 呼吸器依賴個案呼吸器依賴個案排除收案主要因素人數分布排除收案主要因素人數分布 ………………………………22
Figure 12. 拒絕參與收案之個案拒絕原因分布拒絕參與收案之個案拒絕原因分布 ………………………………………23
Figure 13. 納入收案之個案年齡分布納入收案之個案年齡分布 ………………………………………………24
Figure 14. 納入收案之個案各疾病人數占比納入收案之個案各疾病人數占比 ………………………………………25
Figure 15. 呼吸道症狀和肺功能生理檢測於阻塞性肺病者呼吸道症狀和肺功能生理檢測於阻塞性肺病者(COPD)和非阻塞性肺病者和非阻塞性肺病者(non--COPD)各時間點間曲線變化各時間點間曲線變化 ……………………………………………………………………………………………………………………29
Figure 16. 生活品質於阻塞性肺病者生活品質於阻塞性肺病者(COPD)和非阻塞性肺病者和非阻塞性肺病者(non--COPD)各時間點間曲線變各時間點間曲線變化 …………………………………………………………………………………………………………………………………30
Figure 17. 呼吸道症狀和肺功能生理檢測於各年齡分層各時間點間曲線變化呼吸道症狀和肺功能生理檢測於各年齡分層各時間點間曲線變化 …………………………33
Figure 18. 生活品質於各年齡分層各時間點間曲線變化生活品質於各年齡分層各時間點間曲線變化 ………………………………………………………………34
Figure 19. 呼吸道症狀和肺功能生理檢測於呼吸道症狀和肺功能生理檢測於日常生活活動日常生活活動量量表表(ADL)做分層做分層各時間點間曲線變各時間點間曲線變化化 ………………………………………………………………………………………………………………………………………………36
Figure 20. 生活品質於生活品質於日常生活活動日常生活活動量量表表(ADL)做分層做分層各時間點間曲線變化各時間點間曲線變化 …………………………37
Figure 21. 呼吸道症狀和肺功能生理檢測於呼吸道症狀和肺功能生理檢測於工具性日常生活活動工具性日常生活活動量量表表(IADL)做分層做分層各時間點間各時間點間曲線變化曲線變化 ………………………………………………………………………………………………………………………………39
Figure 22. 生活品質於生活品質於工具性日常生活活動工具性日常生活活動量量表表(IADL)做分層做分層各時間點間曲線變化各時間點間曲線變化 ………………40
Figure 23. 呼吸道症狀和肺功能生理檢測於呼吸道症狀和肺功能生理檢測於身體質量指身體質量指數數(BMI)做分層做分層各時間點間曲線變各時間點間曲線變化化 ……………………………………………………………………………………………………………………………………………42
Figure 24. 生活品質於生活品質於身體質量指身體質量指數數(BMI)做分層做分層各時間點間曲線變化各時間點間曲線變化 ……………………………………43
                                    

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