96 COPD and Ineffective Breathing Pattern McFarland & McFarlane, 1997/2008 COPD ㈠ COPD Vermeeren, Wouters, Geraerts-Keeris, & Schols, 2004 ㈡ tumor nec

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1 95 慢性阻塞性肺疾病病人低效性呼吸型態之護理 1 國軍台中總醫院加護病房護理師陳慧雯 1 李雅欣 2 王桂芸 3* 2 國防醫學院護理系講師護理部副主任暨國防醫學院護理系兼任教授 3 台北榮民總醫院摘要 : 慢性阻塞性肺疾病 (chronic obstructive pulmonary disease, COPD) 為一長期慢性且無法完全恢復的呼吸道疾病, 病人必須終身與此疾病共存此類病人常因疾病特性而影響其正常的通氣功能, 當病人吸氣或吐氣無法提供足夠的通氣, 無法維持肺部適當的擴張和收縮, 就會產生低效性呼吸型態的問題, 長久下來不但會造成病人生理心理與行為的改變, 更可能影響個體之情緒活動及生活品質, 護理人員要處理慢性阻塞性肺疾病病人之低效性呼吸型態的問題, 必須從造成的原因著手, 包括改善呼吸肌功能改善肺擴張受限情形及維持呼吸道通暢三方面, 因此筆者針對相關議題統合相關實證文獻, 期能作為臨床護理人員在照護此類病人的參考關鍵詞 : 慢性阻塞性肺疾病低效性呼吸型態照護 chronic obstructive pulmonary disease, COPD Rabe et al., COPD COPD COPD COPD COPD Rabe et al., 2007 COPD COPD *

2 96 COPD and Ineffective Breathing Pattern McFarland & McFarlane, 1997/2008 COPD ㈠ COPD Vermeeren, Wouters, Geraerts-Keeris, & Schols, 2004 ㈡ tumor necrosis factor-α, TNF-α cytokine COPD Wüst & Degens, 2007 McFarland & McFarlane, 1997/2008 (Andenæs, Kalfoss, & Wahl, 2004) COPD 20 40% Coventry, Prescott, Lange, & Vestbo, 1999 modified Borg scale 10 muscle mass fatfree mass X 2007 McFarland & Mc- Farlane 1997/2008 COPD

3 97 COPD ㈠ corticosteroid Rabe et al., 2007 ㈡ 77% COPD active cycle breathing Tang, Taylor, & Blackstock, 2010 Lapin, 2002 Crowe, Geddes, Brooks, & Reid, 2006 BiPAP 2009 Crowe et al., 2006 COPD ㈠ body mass index, BMI muscle mass fat-free mass COPD Girón et al., 2009 COPD Weekes, Emery, & Elia, 2009 COPD 1.5~2g COPD Cai et al., 2003 COPD Progestogens megestrol acetate cytokine Weisberg et al., 2002 ㈡ Crowe et al.,

4 98 COPD and Ineffective Breathing Pattern Gupta & Brooks, 2006 Shoemaker Donker LaPoe 2009 COPD COPD COPD 2007 COPD COPD [Wang, K. Y. (2007). Nursing management of the respiratory system. In H. E. Liu (Ed.), Adult health nursing (4th ed., pp ). Taipei City, Taiwan, ROC: Farseeing.] [Wu, M. F., Chiang, M. H., Cho, H. Y., Shiao, H. F., Haung, C. C., & Hsieh, M. J. (2008). The impact on exercise capacity and life quality one year after pulmonary rehabilitation in patient with COPD. Journal of Respiratory Therapy, 7(2), 81.] [Lin, P. H., Chen, P. P., & Lee, J. D. (2009). Outcome of in patient with chronic obstructive pulmonary disease requiring non invasive positive pressure ventilator. Journal of Respiratory Therapy, 8(2), ] [Chao, Y. F., Tang, H. P., & Tseng, S. W. (2003). The effect of modified abdominal breathing on promoting pulmonary function and activity in COPD patient. Formosan Journal of Medicine, 7(4), ] McFarland, G. K., & McFarlane, E. A [McFarland, G. K., & McFarlane, E. A. (2008). Nursing diagnosis & intervention: Planning for patient care (S. S. Chou, J. M. Ou, S. H. Tsai, P. S. Kang, M. J. Yeh, B. Y. Chang, S. M. Pai, & R. H. Cheng, Trans.). Taipei City, Taiwan, ROC: Farseeing.] Andenæs, R., Kalfoss, M. H., & Wahl, A. (2004). Psychological distress and quality of life in hospitalized patients with chronic obstructive pulmonary disease. Journal of Advanced Nursing, 46(5), Cai, B., Zhu, Y., Ma, Y., Xu, Z., Zao, Y., Wang, J., et al. (2003). Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients. Nutrition, 19(3), Coventry, P. A. (2009). Does pulmonary rehabilitation reduce anxiety and depression in chronic obstructive pulmonary disease? Current Opinion in Pulmonary Medicine, 15(2), Crowe, J., Geddes, E., Brooks, D., & Reid, W. (2006). Inspiratory muscle training for individuals with cervical spinal cord

5 99 injury or chronic obstructive pulmonary disease: A survey of Canadian physical therapists. Physiotherapy Canada, 58(4), Girón, R., Matesanz, C., García-Río, F., de Santiago, E., Mancha, A., Rodríguez-Salvanés, F., et al. (2009). Nutritional state during COPD exacerbation: Clinical and prognostic implications. Annals of Nutrition & Metabolism, 54(1), Gupta, R., & Brooks, D. (2006). Aerobic exercise for individuals with chronic obstructive pulmonary disease. Physiotherapy Canada, 58(3), Lapin, C. D. (2002). Airway physiology, autogenic drainage, and active cycle breathing. Respiratory Care, 47(7), Prescott, E., Lange, P., & Vestbo, J. (1999). Socioeconomic status, lung function and admission to hospital for COPD: Result from the copenhagen city heart study. European Respiratory Journal, 13(5), Rabe, K. F., Hurd, S., Anzueto, A., Barnes, P. J., Buist, S. A., Calverley, P., et al. (2007). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. American Journal of Respiratory Critical Care Medicine, 176(6), Shoemaker, M. J., Donker, S., & LaPoe, A. (2009). Systematic review: Inspiratory muscle training in patients with chronic obstructive pulmonary disease: The state of the evidence. Cardiopulmonary Physical Therapy Journal, 20(3), Tang, C. Y., Taylor, N. F., & Blackstock, F. C. (2010). Chest physiotherapy for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD): A systematic review. Physiotherapy, 96(1), Vermeeren, M. A. P., Wouters, E. F. M., Geraerts-Keeris, A. J. W., & Schols, A. M. W. (2004). Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation: A randomized controlled feasibility trial. Clinical Nutrition, 23(5), Weekes, C. E., Emery, P. W., & Elia, M. (2009). Dietary counseling and food fortification in stable COPD: A randomized trial. Thorax, 64(4), Weisberg, J., Wanger, J., Olson, J., Streit, B., Fogarty, C., Martin, T., et al. (2002). Megestrol acetate stimulates weight gain and ventilation in underweight COPD patient. Chest, 121(4), Wüst, R. C., & Degens, H. (2007). Factors contributing to muscle wasting and dysfunction in COPD patients. International Journal of COPD, 2(3),

6 100 COPD and Ineffective Breathing Pattern Ineffective Breathing Pattern Care for COPD Patients Hui-Wen Chen 1 Ya-Hsin Lee 2 Kwua-Yun Wang 3 * 1 RN, MSN, Intensive Care Unit, Taichung Armed Forces General Hospital; 2 RN, MSN, Instructor, School of Nursing, National Defense Medical Center; 3 RN, PhD, Assistant Director, Department of Nursing, Taipei Veterans General Hospital & Adjunct Professor, School of Nursing, National Defense Medical Center. Abstract: Chronic obstructive pulmonary disease (COPD) is a long-term, chronic respiratory disease from which patients never fully recover. COPD patients usually face abnormal aeration caused by the disease. Patients that are unable to breathe and aspirate adequately and maintain lung appropriate expansion and contraction are considered to have ineffective breathing patterns. This causes physical, psychological and behavioral changes in COPD patients and impacts their emotional condition, daily activities and quality of life. Nurses who care for COPD patients with ineffective breathing patters can improve breathing muscle functions, improve respiration and keep the airway clean. In this paper, the author reviews and integrates relevant findings on this subject from the empirical literature in order to assist clinical nurses responsible for the care of COPD patients. Key Words: chronic obstructive pulmonary disease (COPD), ineffective breathing pattern, care. Accepted for publication: May 30, 2011 *Address correspondence to: Kwua-Yun Wang, No. 201, Shipai Rd. Sec. 2, Beitou District, Taipei City 11217, Taiwan, ROC. Tel: +886 (2) ; kywang7@vghtpe.gov.tw

肺擴張不全導致缺氧, 需緊急放置氣管內管合併人工呼吸器使用 (Panayiotis et al., 2002) 二 ( ) 呼吸照 : 準備脫離呼吸器時, 呼吸生指數需達下列標準 : 最大吸氣壓 >25c

肺擴張不全導致缺氧, 需緊急放置氣管內管合併人工呼吸器使用 (Panayiotis et al., 2002) 二 ( ) 呼吸照 : 準備脫離呼吸器時, 呼吸生指數需達下列標準 : 最大吸氣壓 >25c 劉萍林玉鳳 * 張月娟 ** 廖淑貞 *** 中文摘要本文探討病, 筆以羅氏適應模式為評估工具, 藉訪談觀察及身體評估進行資料收集, 確立健康問題有 : 呼吸道清除功能失效身體活動功能障礙便秘及焦慮照期間採計劃性呼吸器脫離訓練訂定