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題名 | 針灸對改善在加護病房及呼吸照護病房中延長使用呼吸器患者的呼吸狀態之成效評估=Multiplex Development of Chinese Medicine |
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作者姓名(中文) | 陳稼洺; | 書刊名 | 中醫藥年報 |
卷期 | 12 2023.10[民112.10] |
頁次 | 頁(4)1-(4)42 |
分類號 | 413.91 |
關鍵詞 | 呼吸器; 延長使用呼吸器; 脫離呼吸器; 呼吸照護中心; 針灸; 呼吸頻率; 潮氣容積; 淺快呼吸指標; 每分鐘通氣量; Ventilator; Receive prolonged mechanical ventilation; Weaning; Intensive care unit; ICU; Respiratory care center; RCC ; Acupuncture; Respiratory rate; RR; Tidal volume; TV; Rapid shallow breathing index; RSBI; Minute ventilation; |
語文 | 中文(Chinese) |
中文摘要 | 研究目的: 長期使用或依賴呼吸器,不僅消耗昂貴的醫療費用及龐大的醫療資源, 危及病患的生理及心理狀態,使其伴隨罹病率及死亡率增加,像是發生呼吸 器相關肺炎(Ventilator-associated pneumonia,VAP)、氣胸、高濃度氧氣肺 毒症、睡眠阻斷、瞻妄、憂鬱、聲帶麻痺、氣管出血等等,都會降低病患及 家屬的生活品質。 能否盡快呼吸器的脫離是臨床上非常值得關心的議題,因此本研究計畫 以彰化基督教醫院的呼吸照護中心(RCC)中,以有延長使用呼吸器的患者為 對象,分析比較在有讓中醫科針灸治療共同照護,與僅接受西醫常規治療的 患者,是否在呼吸狀態如淺快呼吸指數(RSBI)的改善率、脫離呼吸器成功率、 脫離呼吸器所需時間、於呼吸照護中心(RCC)住院天數等方面有明顯療效, 以期能提供未來在中西醫共同照護執行的處置參考。 研究方法: (一)實施方式: 本研究是實用性隨機預試驗(pragmatic controlled trial,PCT),研究對象 是預估 120 位來自彰化基督教醫院的呼吸照護中心(RCC)中有呼吸器依賴 的患者,且因凡轉入 RCC 且有呼吸器使用者 1。患者以隨機方式分成針灸 實驗組 60 人及對照組 60 人。 針灸實驗組除接受西醫常規治療外,每次給予每個患者共 17 個穴位(關 元穴 CV4、尺澤穴 LU5 雙側、內關穴 PC6 雙側、合谷穴 LI4 雙側、足三里穴 ST36 雙側、上巨虛穴 ST37 雙側、下巨虛穴 ST39 雙側、三陰交穴 SP6 雙側、太衝穴 LR3 雙側)針灸治療,每個穴位針灸停留 20 分鐘後拔針。每 個患者每日 1 次針灸,每周 6 次,治療 2 周,共 12 次的針灸療程。 對照組則僅接受西醫常規治療,沒有接受針灸處置。 (二)評估及統計方法: 本研究紀錄採用了 4 種量化數據,包含與呼吸器戒斷相關的呼吸頻率 (respiratory rate, RR,f)、潮氣容積(Tidal Volume, TV)、淺快呼吸指數(rapid shallow breathing index, RSBI)、與每分鐘通氣量(Minute ventilation, MV),去 做記錄、分析和評估。其中,淺快呼吸指數(rapid shallow breathing index, RSBI) 為呼吸器戒斷(try weaning )最具參考指標的呼吸參數,一般會在患者的淺快 呼吸指數(RSB)數值下降至 105 以下之際,該患者即達到適合開始呼吸器戒 斷作業,訓練自主呼吸能力的時機。 統計方法上,本試驗會採用 SPSS 17.0 版統計軟體,使用成對樣本 t 檢 定、獨立樣本 t 檢定、卡方檢定、t-teat 的迴歸分析,且以描述性統計進行 評估。描述性統計以百分比、平均數、標準差及範圍,描述實驗組和對照組 受試者的呼吸頻率(RR)、潮氣容積(TV)、淺快呼吸指標(RSBI)、每分鐘通氣 量(MV)之分佈。所有統計 α 值訂為 0.05,p 小於 α 為統計之意義,若最終 P 值< 0.05,則表示統計上針灸對於改善 延長使用呼吸器患者的呼吸狀態 或促進其成功戒斷呼吸器使用(wean from MV)之是有顯著差異的。 主要發現、結論與建議: 本研究經統計分析後發現,由卡方檢定可發現在資料統計截止前,與對 照組相比,實驗組在針灸介入治療對成功脫離呼吸器與否有顯著差異 (P<0.05)。 與治療前之呼吸器參數相比,在離第 12 次治療後最接近的實驗組個案 之平均淺快呼吸指數(RSBI)下降改善的幅度 較對照組大。因此由結果來看, 我們推論針灸治療可透過改善呼吸器依賴患者之淺快呼吸指數(RSBI),進一 步提升患者的自主呼吸能力,以達到幫助脫離呼吸器之效果。 因此可推論相較於對照組,實驗組在結合中西醫整合照護下,治療針灸 的介入,對於呼吸器依賴之患者之呼吸器參數,以及脫離呼吸器(try weaning)與否的預後,具有正向之幫助。 據此,建議在設有中醫部門之全國各大醫學中心,若呼吸照護病房(RCC) 有呼吸困難使用呼吸器照護 且出現延長依賴呼吸器難以脫離自主呼吸的 患者,西醫主治醫師可以考慮讓患者接受中西醫共同照護(combine care)。讓 患者在合格專業的中醫師評估下,接受針灸治療,改善延長使用呼吸器患者 的呼吸狀態與呼吸參數,希望加速達到脫離呼吸器的呼吸參數數值,提高脫 離呼吸器成功率、減少脫離呼吸器所需時間、降低患者在呼吸照護中心(RCC) 之住院天數、並節省醫療成本。 |
英文摘要 | Research Aim: Long-term use or reliance on respirators not only consumes expensive medical expenses and huge medical resources, but also endangers the patient’s physical and psychological state, causing it to increase morbidity and mortality, such as the occurrence of ventilator-associated pneumonia (VAP), pneumothorax, high-concentration oxygen pulmonary toxicity, sleep blockade, paranoia, depression, vocal cord paralysis, tracheal hemorrhage, etc., that will reduce the quality of life of patients and their families. Whether the respirator can be detached as soon as possible is an issue of great clinical concern. Therefore, this research is to compare the patients who received acupuncture treatment together with regular western medicine treatment and the patients with only regular western medicine treatment in the Respiratory Care Center (RCC) of Changhua Christian Hospital. Whether the respiratory status such as rapid shallow breathing index (RSBI), the success rate of detachment from the respirator, the time required to detach from the respirator, and the hospitalization days, etc., can be improve in order to provide a reference for the treatment of joint care of Chinese and Western medicine in the future. Method: This study record uses 4 types of quantitative data, including respiratory rate (RR, f), tidal volume (TV), and rapid shallow breathing index (RSBI) related to respiratory withdrawal. , And Minute ventilation (MV), to record, analyze and evaluate. Among them, the rapid shallow breathing index (RSBI) is the most important respiratory parameter for try weaning (try weaning), and it usually occurs when the patient's rapid shallow breathing index (RSBI) drops below 105 , The patient has reached the right time to start ventilator withdrawal operation and train spontaneous breathing ability. In terms of statistical methods, this experiment will use SPSS version 17.0 statistical software, using paired sample t test, independent sample t test, chisquare test, t-teat regression analysis, and use descriptive statistics for evaluation. Descriptive statistics describe the respiratory rate (RR), tidal volume (TV), rapid shallow breathing index (RSBI), and ventilation per minute (MV) of the experimental group and control group in percentage, mean, standard deviation and range. Of the distribution. All statistical α values are set to 0.05, and p is less than α for statistical significance. If the final P value <0.05, it means that acupuncture is statistically useful for improving the respiratory status of patients with prolonged use of respirators or promoting their successful withdrawal from respirators (wean from MV) is a significant difference. Results & Recommendation: Compared with the respirator parameters before treatment, the average rapid shallow breathing index (RSBI) of the patients in the experimental group closest to the 12th treatment decreased and improved more than the control group. Therefore, from the results, we conclude that acupuncture can improve the rapid shallow breathing index (RSBI) of patients with respirator dependence, and further enhance the patient's spontaneous breathing ability to help get out of the respirator. Therefore, it can be inferred that compared with the control group, the experimental group has a positive prognosis for the treatment of acupuncture under the integrated care of traditional Chinese and Western medicine, as well as the prognosis of the respirator parameters of the patients dependent on the respirator, and the prognosis of whether to leave the respirator (try weaning) or not. Based on this, it is recommended that in major medical centers across the country which have traditional Chinese medicine departments, if the respiratory care center (RCC) has paitients with difficulty breathing and uses respirators in difficult to escape from spontaneous breathing, the attending physician of Western medicine can consider letting the patient receive combined care of Chinese and Western medicine. Allow patients to receive acupuncture treatment under the evaluation of qualified professional Chinese medicine practitioners to improve the breathing state and respiratory parameters of patients who use the respirator for extended periods of time, hoping to accelerate the reaching of the respiratory parameter value of the respirator, increase the success rate of detachment from the respirator, also reduces the number of days a patient stays in a respiratory care center (RCC), and saves medical costs. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。