建立慢性阻塞性肺疾病患者日常活動耗氧量之標準並分析其影響因素
Standard Establishment and Related Factors Analysis of Oxygen Consumption of ADL in Patients with Chronic Obstructive Pulmonary Disease
中文摘要
本研究目的有四：(一)建立慢性阻塞性肺疾病患者執行日常活動的耗氧量標準。
(二)比較慢性阻塞性肺疾病患者與健康人執行日常活動與運動測試中呼吸困難 症狀之改變。(三)比較慢性阻塞性肺疾病患者與健康人執行日常活動與運動測試 耗氧量之差異。(四)分析影響日常活動耗氧量之因素。
以立意取樣法( purposive sampling )選取台北市某三家區域教學級以上醫院符合 選樣條件之 22 位慢性阻塞性肺疾病患者（COPD 組），及 18 位依年齡、身高、
體重相符配對之健康人（控制組）為對象。採問卷、日常活動（靜坐、站立、慢 走、提重物走路與走上二層樓，共五項）及運動測試三種方式進行資料收集。資 料分析採用百分比、平均值、標準差、t 檢定、及皮爾森積差相關等統計方法。
本研究結果發現：(一)慢性阻塞性肺疾病患者日常活動的平均耗氧量為：靜坐 3.41
（+0.82）ml‧kg-1‧min-1，站立 3.67（+0.90）ml‧kg-1‧min-1，慢走 10.06（+2.19）
ml‧kg-1‧min-1，提重物走路 10.28（+1.65）ml‧ kg-1‧min-1，走上二層樓 8.16（+1.36）ml‧kg-1‧min-1。(二)COPD 組執行相同日常活動及運動測試時的 呼吸困難指數確實比控制組高，顯示 COPD 組呼吸困難症狀明顯嚴重於控制組。
(三)兩組個案在執行五項日常活動時耗氧量並無差異，但運動測試之尖峰耗氧量
（VO2peak），COPD 組 13.90 （+2.93）ml‧kg-1‧min-1 明顯低於控制組 16.15
（+1.86）ml‧kg-1‧min-1（p = 0.01），顯示 COPD 組心肺功能較控制組差。(四) 在日常活動與運動測試之耗氧量與影響因素上，發現 COPD 組與控制組有很大 差異。在日常活動中，控制組與現在抽煙史及生活型態有密切相關，顯示抽煙雖 對健康人尚未造成生理上的影響，但已造成日常生活中無形的傷害；然而在 COPD 組無此發現，可能因為患者肺部生理功能已有障礙，且患者大都採靜態生 活型態，故顯現不出相關性。
此外，COPD 組肺功能障礙程度及呼吸困難程度與尖峰耗氧量有密切相關，尤其 在呼吸困難屬中-重度的老年患者，不管其肺功能的嚴重程度，尖峰耗氧量都比 輕度呼吸困難者低，顯示呼吸困難程度對尖峰耗氧量之影響比肺功能的嚴重度更 大。
英文摘要
The purpose of this study was to (1) standard establishment of oxygen consumption ( VO2 ) of ADL in patients with COPD. (2) compared the dyspnea rating during ADL and exercise testing in patients with COPD and normal subjects. (3) compared the VO2 of ADL and VO2peak of exercise testing in patients with COPD and normal subjects. (4) related factors analysis of VO2 of ADL.
A explored — correlated design was used. VO2 of ADL ( sitting, standing, walking, walking with 2kg goods, and walking upstairs in a two — story building ) and exercise testing were measure in 22 patients with COPD and compared with those of 18 age, weight, height matched control subjects. Data were collected by means of questionaires, VO2 of ADL, and peak exercise testing. Data was analyzed by percentage, mean, standard deviation, T test, and Pearson correlation.
The major finding of this study were as follows: (1) mean VO2 of ADL in patients with COPD was: sitting 3.41（+0.82）ml‧kg-1‧min-1, standing 3.67（+0.90）ml‧
kg-1‧min-1, walking 10.06（+2.19）ml‧kg-1‧min-1, walking with 2kg goods 10.28
（+1.65）ml‧kg-1‧min-1, and walking upstairs 8.16（+1.36）ml‧kg-1‧min-1. (2) The dyspnea rating of ADL and exercise testing in COPD group ( n=18 ) was higher than control group ( n=18 ). We finding dyspnea limits the independent function and activity tolerance in COPD group. (3) There were no differences at VO2 of ADL between the two groups, but VO2peak was significantly lower in the COPD group ( 13.90 + 2.93 ml‧kg-1‧min-1 ) compared with the control group ( 16.15 + 1.86ml‧
kg-1‧min-1 ) (p = 0.009). So, the cardiorespiratory function in COPD group was worse than control group. (4) Smoking and regular exercise were correlated with VO2 of ADL in control group. Lung function ( FEV1) and dyspnea rating ( BDI ) were high correlation with VO2peak in the COPD group, and we finding the dyspnea rating was more important than lung function.
