慢性阻塞性肺疾病患者使用呼吸器之經驗
Experience of Using Mechanical Ventilation Among Patients with Chronic Obstructive Pulmonary Disease
中文摘要
研究的目的，主要在探討慢性阻塞性肺疾病患者對呼吸器使用之經驗。採質性研 究之深度訪談及內容分析，訪談八位因急性呼吸衰竭而首次接受呼吸器通氣治 療的慢性阻塞性肺疾病患者，得到受訪者主觀的描述性資料。經內容分析法，獲 得慢性阻塞性肺疾病患者在使用呼吸器之經驗的三個主題，分別為「瀕死的桎 梏」、「煎熬的經歷」和「力求生存」。
在瀕死的桎梏主題中有「無法預知病情」、「無盡的過程」及「死亡的威脅」三個主 要類屬。當慢性阻塞性肺疾病患者首次因為病情惡化、症狀加劇所導致急性呼吸 衰竭，必須依賴呼吸器維持生命，產生「無法預知病情」及因對治療處置的不明 瞭而深陷於「無盡的過程」，導致必須面對「死亡的威脅」。
在煎熬的經歷中會有「氣喘不上來」、「疲憊」、「受約束失去自由」、「口腔功能剥 削」、「喉嚨痛」、「抽痰的折磨」六個主要類屬出現。慢性阻塞性肺疾病患者在使 用呼吸器，健康出現前所未有的挑戰時仍能「力求生存」，來自於「希望生存」、
「配合治療」、「社會支持」及「自我肯定」此四個纇屬所產生的力量。慢性阻塞性 肺疾病患者期待從一個意識到的困境中改善或釋放，激發希望，利用個別的社 會支持及醫療幫助成功脫離呼吸器，以期能重掌身體變化，建立正向肯定。
此研究結果將讓醫護人員了解此時期COPD 病人使用呼吸器的感受，應把握此
時期病人對自我健康的掌控與關切，在照護此纇病人時能提供全人化的照護，
重視使用呼吸器病人的身心靈各方感受，將有助於病人儘早成功脫離呼吸器，
適應疾病，進而維持較佳的生活品質。
關鍵字：慢性阻塞性肺疾病患者、呼吸器、經驗
英文摘要
The purpose of this study is to explore the experiences of using mechanical
ventilation among patients with chronic obstructive pulmonary disease（COPD）. It was conducted by qualitative method of in-depth interview and content analysis. Data were collected through interview guidelines and audiotapes recorded with 8 first using mechanical ventilation among patients with COPD with acute respiratory failure who experiences. Three themes were generated:（1）dying shackle,（2）suffering process, and（3）struggle to survive.
The dying shackle theme three categories:（1）unpredictable condition,（2）endless progression, and（3）threaten of dying. As patients with COPD first encounter their deteriorating condition and lead to respiratory failure which must be dependent of ventilator to support their life, it results in unpredictable condition and unwarranted of
the treatment procedure which will lead to endless progression seriously and must to face of the threaten of dying. During the suffering process, there are 6 categories:
（1）short of breath and dyspnea,（2）loss of energy and fatigue,（3）loss of sovereignty,（4）strip of mouth function,（5）sore throat, and （6）afflictive suction.
The COPD patients with ventilator who meet the challenge they first encounter to their health still can“struggle to survive”, the power comes from 4 categories:
（1）hope for survive,（2）compliance of treatment,（3）support of society, and（4）self-confirmation. The COPD patients desire that, be ware of changing or releasing from a bad environment their hope, then weaning the ventilator by private society support and medical management, in hope of handling their body condition and positive confirmation.
The result of this study will make medical service staffs to understand that feelings of COPD patients in the period with ventilator, and they should catch chance of the period for handling and caring patients self-health. While caring such patients, if we can support whole human care and make the feeling of physical, psychical, and spiritual of patients with ventilator more important, it will help these patients weaning the ventilator as soon as possible, tolerant of disease, and maintain their life quality more better.
Key words: COPD, Ventilator, Experience
