呼吸器依賴患者的生活功能及生活品質

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呼吸器依賴患者的生活功能及生活品質

Functional Status and Quality of Life in

Ventilator-Dependent Patients

江玲玲;吳清平;王儷穎;吳英黛

摘要

目的:本研究在評估呼吸器依賴患者之生活功能程度及生活品質,並測試所選用 量表之再測信度及關聯性。方法:訪查一所醫學中心、一所區域醫院和一所地區 醫院附設之呼吸照護病房的呼吸器依賴病患。取得意識清楚、昏迷指數10分(因 皆為氣切患者)、能夠受訪且同意的呼吸器依賴病患共29名,參與本研究。除記 錄病患基本資料、疾病分类、呼吸器使用天數及形式之外,並進行生活功能及生 活品質量表之調查和一週內之再測信度測試。生活功能評估是採用巴氏量表及功 能獨立自主量表,生活品質評量則採用健康生活品質量表(SF=36)。再測信度是 以完成第二次評估之病患做為樣本分析。結果:29位病患平均年齡為73.5±11.5 歲,其中大於70歲者佔70%,呼吸器使用半年以上者佔45%,主要診斷為慢性阻 塞型肺疾者(佔52%)。病人之巴氏量表平均得分2.1±3.9分、功能獨立自主量表 動作和認知領域平均分別為20.4±14.6與18.6±6.3分,生活品質量表之身體、心智 範疇平均分別為21.5±7.6與42.0±10.3分。病患之生活功能及生活品質無論是以年 齡、疾病診斷或呼吸器使用天數來分類,組間均無明顯差異。巴氏量表、功能獨 立自主量表與生活品質量表之内在等級相關係數(ICC)分別為0.995、0.926-1.000、 與0.874-1.000。巴氏與功能獨立自主量表之動作領域得分和總分呈顯著相關,r 值分別為0.877及0.729(p<0.001),生活品質與任一生活功能量表得分無明顯相關。 結論:本研究發現長期依賴呼吸器病患之生活功能和生活品質得分均低,應加關 切和治療,予以提升。以不同年齡、疾病診斷及呼吸器使用天數分組,其組間之 生活功能或生活品質均無顯著差異。巴氏量表、功能獨立自主量表和生活品質量 表應用於呼吸器依賴患者之再測信度均高,而這些病人之生活功能和生活品質量 表得分之間無顯著相關。

Abstract

Purposes: In the present study, we evaluated the functional status and quality of life(QOL) in ventilator-dependent patients using standardized measurement tools. The reliability of these tools and relationships between them were also examined. Methods: Twenty-nine ventilator-dependent patients with clear consciousness at three respiratory care settings(respiratory care center, general wards of a medical center and a regional hospital, and respiratory care

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ward of a local hospital) were interviewed. Measurement tools employed in the interview process included the Barthel Index (BI) and Functional

Independence Measure (FIM) for functional status measurement, and Short-Form 36 Items Health Survey (SF-36) for generic QOL assessments. Eighteen patients were interviewed twice in one-week period to measure the test-retest reliability. Results: The average age of the subjects was 73.5±11.5 years. Seventy percent of the patients were over 70 years old,45% of them had been using ventilator for more than half a year, and 52% of them had a chronic obstructive pulmonary disease (COPD).The results were as follows: The mean BI score was 2.1±3.9.The mean scores on the motor and cognitive domains of the FIM were 20.4±14.6 and 18.6±6.3,respectively.The mean scores on the physical and mental domains of the SF-36 were 21.5±7.6 and 42.0±10.3,respectively.Scores on FIM and SF-36were not significantly different across groups categorized by age, diagnosis, or duration on

mechanical ventilator. The intra-class correlation coefficient(ICC)was 0.995 for BI,0.926 to 1.000 for FIM, and 0.874 to 1.000 for SF-36.The BI scores

correlated significantly (p<0.001) with FIM scores in motor

domain(r=0.877)and total scores (r=0.729). No correlation was found between functional status measurements and QOL scores. Conclusion: This study was the first attempt to measure the functional status and QOL of

ventilator-dependent patients in Taiwan. Their average scores of the functional status and QOL were relatively low, and were not associated with age,

diagnosis, or duration on ventilator. Good test-retest reliability for BI, FIM, and SF-36 instruments was found. There appears no significant relationship between measurements of functional status and QOL in these patients.

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