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題名:氣喘病患居家肺部復健之成效:病例報告     (12點)
Efficacy of Home-Based Pulmonary Rehabilitation for A Patient with Asthma: A Case Report
著者:江玲玲(Ling-Ling Chiang) ;王儷穎(Li-Ying Wang) ;吳英黛(Ying-Tai Wu)
出版地區:台灣
出版城市:台北市
學科:物理 ; 醫學綜合
刊名:物理治療
卷期:27卷4期(2002.8)
頁碼:191-196
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

背景與目的:氣喘病人因慢性持續性氣道發炎及長期痰液積聚,使肺功能愈來愈惡化。病患因呼吸困難增加,活動量亦隨之漸減,睡眠通氣不足更加劇上述現象,導至日後心肺症。本個案報告探討居家肺部復健強調夜間通氣支持對一位氣喘病患的成效。方法:本文之個案是位一66歲女性病患,近年來經常因病情惡化住院。本次住院期間接受物理治療評估及協助如下:l.有效清除痰液;姿位引流,用力呼氣技巧;2.日常生活及運動中呼吸配合策略;3.上肢運動;及4.夜間使用鼻罩雙期正壓呼吸輔助器。出院後6個月,仍維持居家有效清痰、運動及夜間使用鼻罩雙期正壓呼吸輔助器。病患在治療前後接受下列評估:日間動脈血氣體分析、6分鐘行走距離,並記錄再住院次數。結果,持續居家肺部復健6個月,發現日間動脈血氣體分析資料有明顯改善。二氧化碳分壓(PaCO2)由58.3降低至39.6 mmHg,氧分壓(PaO2)由51.5增至58.2mmHg。運動能力也有提昇,患者在6分鐘內所能行走的距離由330公尺增加至419公尺,且測試過程中呼吸困難的程度也下降。個案在此6個月內,不曾有再住院的記錄。結論:由此個案,我們發現有效的清痰技巧、合宜的運動訓練,合併適當的居家夜間通氣支持治療,的確可以改善日間動脈血氣體分壓值、運動能力、和呼吸困難的現象,可能還有助於日後更積極的肺部復健計劃。
Background and Purpose: In patients with asthma, chronic persistent airway inflammation and mucus impaction often lead to deteriorating pulmonary function. Asthma related breathlessness sets up a vicious cycle leading to physical deconditioning. Nocturnal hypoventilation exaggerates this condition and might eventually lead to cor pulmonale. In this report, we investigated the efficacy of nocturnal ventilatory support adjunct to home pulmonary rehabilitation program in an asthma case. Methods: We reported a 66 year- old female patient with poor controlled asthma, which caused repeated hospitalization in recent years. During this hospitalization, she was referred to physical therapy. Based on the initial assessment, physical therapy treatment plans were as follows: 1) postural drainage combined with forced expiratory technique to improve lung hygiene; 2) paced breathing technique during daily activities and exercises; 3) upper extremity exercises; 4) ventilatory support via nasal mask (bi-level positive airway pressure, BiPAP). Home programs included airway clearance techniques, exercise and nocturnal nasal BiPAP ventilatory support. Arterial blood gas and six-minute walk test were assessed before and after the intervention, and readmission rate was also recorded. Results: The patient had monthly follow-up for 6 months after discharge. The arterial blood gas measured 6 months after discharge demonstrated that partial pressure of carbon dioxide (PaCO2) decreased from 58.3 to 39.6 mmHg, and partial pressure of oxygen (PaO2) increased from 51.5 to 58.2 mmHg. Furthermore, the distance the patient could walk in 6 minutes increased from 330 to 419 meters with less dyspnea. No admission to hospital occurred in this 6-month period. Conclusions: The combination of airway clearance technique and appropriate exercise training and nocturnal ventilatory support could effectively improve daytime blood gas tensions, exercise tolerance, and decrease dyspnea, and might thus potentiate further pulmonary rehabilitation program intervention.


    

本卷期目次
物理治療 27卷4期 (2002.8)
跌倒對台灣鄉村社區老人日常生活活動能力衰退與害怕跌倒心理的影響/ 蔡素蘭林茂榮
軀幹肌肉表現測試:相關性以及量測方法信度之探討/ 楊雅如王子綺楊正蕾王瑞瑤
功能獨立量表訪談式問卷於腦中風病人之信度檢定/ 廖麗君林昭宏朱允慧劉景寬
大專音樂系學生肩頸疼痛之形成-音樂系與非音樂系女大學生之比較/ 陳文玲王君仙劉培鈴程琡敏
氣喘病患居家肺部復健之成效:病例報告/ 江玲玲王儷穎吳英黛
系統性紅斑性狼瘡伴隨橫斷性脊髓炎之物理治療:病例報告/ 張婉如陳乃鈺
 
   
 
   

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