| Summary: | 碩士 === 嘉南藥理大學 === 醫務管理系 === 107 === The difficulty of weaning from the ventilator for ventilator-dependent patients who suffer from reduced activity and lower muscle strength increases psychological stress of patients and their families. It also increases burdens of medical care professionals. Pulmonary rehabilitation can improve muscle tolerance and physical activity ability to increase the rate of successful ventilator weaning. Therefore, the purpose of this study is to investigate the effectiveness of the muscle strength and grip strength after pulmonary rehabilitation and explore affecting factors of the ventilator weaning successfully.
Data was collected from retrospective medical records and analyzed. We reviewed 151 cases of ventilator-dependent patients in a subacute respiratory care ward at a medical center from January, 2015 to December, 2016. A proper pulmonary rehabilitation was arranged for patients admitted to the ward. The pulmonary rehabilitation was performed for 30 minutes twice daily during the visiting time. The muscle strength and grip strength were evaluated at the time of admission, before the transfer, and once per week to investigate the effectiveness of the pulmonary rehabilitation. Measure tools include a muscle test scale and the hydraulic handgrip dynamometer (JAMAR). The effectiveness of muscle strength and grip strength after the pulmonary rehabilitation were analyzed by the paired t test. Differences among gender, age, consciousness, disease severity, diagnosis, length of hospital stay were analyzed by independent t test and chi square test. Logistic regression was used to predict factors of successful weaning from the ventilator.
Results of this study showed that the ventilator-dependent patients had significant improvement in upper limb strength (p = 0.000), lower limb strength (p = 0.000), and grip strength (p = 0.000) after performing pulmonary rehabilitation exercises. Significant differences of the coma index score (p = 0.005), the disease severity (p = 0.003), the gap score of upper muscle strength (p = 0.000), the gap score of lower limb muscle strength (p = 0.000) and the gap score of grip strength ( p = 0.016) were found between successful ventilator weaning patients and failed ventilator weaning patients. Results of logistic regression showed that the coma index (p = 0.017), the gap score of lower limb muscle strength (p = 0.001) and the gap score of grip strength (p = 0.035) were significant predictive factors of successful ventilator weaning.
This study confirms that pulmonary rehabilitation can significantly improve the muscle strength of the limbs and the grip strength. We suggest that ventilator-dependent patients should implement pulmonary rehabteamilitation earlier. Clinically, the practice of pulmonary rehabilitation still depends on all efforts of the professional teamwork. Patients and their families should cooperate with the healthcare team to achieve a win situation for policy, medical care and health.
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