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系統識別號 U0026-0812200914060241
論文名稱(中文) 不同呼吸法操作誘導型肺計量器對心臟手術後病患肺功能及心率變異之影響
論文名稱(英文) The Effect of Different Breathing Methods Using Incentive Spirometry on Pulmonary Function and Heart Rate Variability in Patients after Cardiac Surgery
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 96
學期 1
出版年 97
研究生(中文) 洪佩瑜
研究生(英文) Pei-Yu Hung
學號 t2694103
學位類別 碩士
語文別 中文
論文頁數 94頁
口試委員 口試委員-張瑩如
指導教授-顏妙芬
召集委員-蔡佩珊
中文關鍵字 心率變異  肺功能  誘導型肺計量器  呼吸法 
英文關鍵字 heart rate variability  pulmonary function  incentive spirometry  breathing method 
學科別分類
中文摘要 誘導型肺計量器普遍應用於心臟手術後病患,作為促進換氣與肺部擴張的方法;然而,臨床實際發現病患操作時深呼吸作法大多是採取會動用到肩頸及胸廓的胸式呼吸,而不是運用腹式呼吸。本研究目的旨比較腹式呼吸法與胸式呼吸法操作誘導型肺計量器在心臟手術後病患肺功能及心率變異影響之差異。
採實驗性設計,選取南部某兩所醫學中心接受正中胸骨切開之心臟手術病患共計31位,以抽籤方式隨機分派至兩組;組一(n = 16)介入腹式呼吸法操作誘導型肺計量器,組二(n = 15)則觀察並確認使用胸式呼吸法操作誘導型肺計量器。兩組操作次數為一天至少四回,一回十次。收集手術前、手術後轉入病房第一天與第三天之肺功能(用力肺活量百分比預測值、第一秒用力呼氣容積百分比預測值),以及每日測量兩次誘導型肺計量器操作前及操作後的心率變異(低頻功率、高頻功率、低頻功率比、高頻功率比、低高頻功率比)與心跳。以重複測量變異數分析檢視兩組在不同時間點肺功能、心率變異與心跳改變量之變化。
研究結果顯示兩組用力肺活量百分比預測值在時間與組別上出現交互作用(F = 9.233; p < .05,且腹式呼吸組比起胸式呼吸組能降低低頻功率比(F = 12.006; p < .05)、低高頻功率比(F = 7.664; p < .05)、心跳(F = 11.511; p < .05)以及增加高頻功率比(F = 12.006; p < .05)。驗證使用腹式呼吸法比使用胸式呼吸法操作誘導型肺計量器的肺功能恢復程度較佳,且能增加副交感神經驅動、降低交感神經驅動與減緩心跳。建議心臟手術後病患操作誘導型肺計量器時需確實以腹式呼吸法操作之。
英文摘要 Incentive spirometry has been commonly used to prevent postoperative lung atelectasis and pulmonary complications in patients who received cardiac surgery. However, clinically when using the incentive spirometry, patients often breathe through the method of stretching their chest unless clinical experts remind them to use abdominal breathing. The aim of this study was to examine the different breathing methods in using incentive spirometry on pulmonary function and heart rate variability in patients after cardiac surgery.
An experimental design was utilized in this study. Thirty-one patients undergoing median sternotomy for cardiac surgery from two medical centers in southern Taiwan were invited to participate. Group 1 (n = 16) received abdominal breathing method as an intervention in using incentive spirometry. Group 2 (n = 15) used incentive spirometry with thoracic breathing method. Implementations of the methods were applied four times daily, and ten tries each time per group.
Both groups received pulmonary function tests (% FVC pred, % FEV1 pred) before the operation and at day 1 and day 3 after postoperative transfer to the general ward. Heart rate variability (LF, LF%, HF, HF%, LF/HF ratio) were measured before the operation, pre and post the implementation of the incentive spirometry twice per day for a consecutive of three days after being transferred to the general ward. Data were analyzed through Repeated measures ANOVA.
The results showed significant interaction between the time and group in the % FVC pred (F = 9.233; p < .05). Additionally, when using the incentive spiromery, LF% (F = 12.006; p < .05), LF/HF ratio (F = 7.664; p < .05), HR (F = 11.511; p < .05) were reduced, and HF% (F=12.006; p < .05) was enhanced during abdominal breathing more than thoracic breathing. The present study demonstrated the optimal lung function recovery and also reflected a shift to the dominance of parasympathetic nerves regulation in using abdominal breathing rather than thoracic breathing with the application of incentive spiromery. We suggest that post-cardiac surgery patients use the abdominal breathing method when employing incentive spiromery.
論文目次 目錄
中文摘要 I
英文摘要 II
誌謝 IV
論文目錄 VI
圖目錄 XI
表目錄 X
附錄目錄 X
附件目錄 X
論文目錄
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 4
第三節 研究問題 4
第二章 文獻查證 5
第一節 呼吸法 5
腹式呼吸 5
胸式呼吸 7
第二節 呼吸法與肺功能之關係 8
肺功能之測量指標 8
心臟手術後病患之肺功能 9
呼吸法與肺功能之相關研究 10
誘導型肺計量器之使用方法與流程 12
誘導型肺計量器應用成效與相關研究 13
誘導型肺計量器之執行方案與流程設計 17
第三節 呼吸法與心率變異之關係 19
心率變異之定義與測量指標 19
心率變異與心臟疾病之關係 21
呼吸法與心率變異之相關研究 22
心率變異測量之干擾因素 26
第三章 研究方法與過程 29
第一節 研究架構 29
第二節 名詞定義 30
第三節 研究假設 31
第四節 研究設計 32
第五節 研究對象與場所 33
第六節 研究工具 34
第七節 資料收集過程 36
第八節 資料分析 38
第九節 倫理考量 39
第四章 研究結果 40
第一節 研究對象基本資料、疾病屬性及誘導型肺計量器操作狀況 40
第二節 不同呼吸法操作誘導型肺計量器對心臟手術後病患肺功能之影響 47
第三節 不同呼吸法操作誘導型肺計量器對心臟手術後病患心率變異之影響 52
第五章 討論 61
第一節 研究對象基本資料、疾病屬性及誘導型肺計量器操作狀況 61
第二節 不同呼吸法操作誘導型肺計量器對心臟手術後病患肺功能之影響 64
第三節 不同呼吸法操作誘導型肺計量器對心臟手術後病患心率變異之影響 67
第六章 結論與建議 71
第一節 結論 71
第二節 應用與建議 72
第三節 研究限制 74
參考資料 75
中文部份 75
英文部分 77
圖目錄
圖2-3.3 生理機制 25
圖3-1.1 研究架構 29
圖3-7.1 執行流程與步驟 37
圖4-2.1 兩組病患用力肺活量百分比預測值(%FVC pred)之比較 50
圖4-2.2 兩組病患第一秒用力呼氣容積百分比預測值(%FEV1 pred)之比較 50
圖4-2.3 兩組病患術後用力肺活量百分比預測值(%FVC pred)恢復程度之差異 51
圖4-2.4 兩組病患術後第一秒呼氣百分比預測值(%FEV1 pred)恢復程度之差異 51
圖4-3.1 兩組病患低頻功率(LF)前後改變量之比較 58
圖4-3.2 兩組病患高頻功率(HF)前後改變量之比較 58
圖4-3.3 兩組病患低頻功率比(LF%)前後改變量之比較 59
圖4-3.4 兩組病患高頻功率比(HF%)前後改變量之比較 59
圖4-3.5 兩組病患低高頻功率比(LF/HF ratio)前後改變量之比較 60
圖4-3.6 兩組病患心跳(HR)前後改變量之比較 60
表目錄
表3-4.1 研究設計 32
表3-6.1心率掃瞄器與三導程心電圖之心跳次數相關性 35
表3-6.2 心率變異重複施測兩次之前後一致性 35
表4-1.1 病患基本資料 43
表4-1.2 病患疾病屬性 45
表4-1.3 誘導型肺計量器操作次數 46
表4-2.1 兩組病患之肺功能變項分析 49
表4-2.2 兩組病患術後的肺功能恢復程度之差異 49
表4-3.1 兩組病患手術前之心率變異變項分析 55
表4-3.2 兩組病患手術後轉入病房之心率變異改變量分析 56
附錄
附錄一 個案基本資料 86
附錄二 個案用藥記錄 87
附錄三 誘導型肺計量器操作記錄 88
附錄四 肺功能及心率變異記錄 89
附錄五 研究參與同意書 90
附件
附件一 人體試驗委員會同意臨床試驗證明書 93
附件二 財團法人奇美醫院人體試驗委員會同意臨床試驗證明書 94
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