以兩種不同非侵入性氧氣治療對癌症末期病人呼吸困難緩解效果之比較

Comparison of the Effects of Relieving Dyspnea in Advanced Cancer Patients with Two Different Noninvasive Oxygen Therapy

10.6142/VGHN.201909_36(3).0005

廖偉真(Wei-Chen Liao)；黃惠美(Hui-Mei Huang)；黃齡慧(Ling-Hui Huang)

癌症末期 ； 呼吸困難 ； 雙相型陽壓呼吸器 ； 多功能霧化器氧氣面罩 ； terminal cancer ； dyspnea ； bi-level positive airway pressure ； all-purpose nebulizer mask

榮總護理

36卷3期（2019 / 09 / 01）

255 - 265

繁體中文

癌症末期病人呼吸困難的治療目標在於症狀緩解，常見非侵入性氧氣治療方式，可選擇雙相型陽壓呼吸器（BiPAP）多功能霧化器氧氣治療（all-purpose nebulizer），或兩者交替使用病人配戴的面罩則作為氧氣輸送的路徑。本研究目的在比較使用BiPAP與all-purpose nebulizer 改善癌症末期病人呼吸困難緩解效果。研究方法在中部某醫學中心，採觀察性研究設計，立意取樣共收案36人。結果發現病人使用BiPAP及all-purpose nebulizer前、後呼吸困難分數在統計上均呈顯著差異（Z_(BiPAP)= -4.50, p ＜ .001；Z_(all-purpose nebulizer)= -3.64, p＜ .001），且BiPAP改善呼吸困難程度較all-purpose nebulizer佳（Z = -2.65, p＜ .01）。以面罩造成的困擾症狀，使用BiPAP面罩的困擾症狀高於all-purposenebulizer面罩（20.61±6.21vs. 8.81±5.39分）。使用BiPAP或all-purpose nebulize皆能緩解病人呼吸困難症狀，以使用面罩產生的困擾症狀而言，BiPAP面罩影響程度相對嚴重。未來臨床醫護人員面對癌症末期呼吸困難病人選擇高流量氧氣治療時，可提供個別性護理，並減少困擾症狀的影響降至最低。

Patients with lung cancer and terminal lung metastases are prone to dyspnea, with the main target of treatment being symptomatic relief. Many options for oxygen treatment are available in the clinic. The purpose of this study was to understand the difference in effect between Bi-level Positive Airway Pressure (BiPAP) and an all-purpose nebulizer mask in improving the dyspnea of terminal cancer patients. An observational study with purposive sampling was adopted, with a total of 36 subjects. The dyspnea scores before and after using BiPAP and an all-purpose nebulizer mask were significantly different (Z_(BiPAP)= -4.50, p ＜ .001；Z_(all-purpose) nebulizer = -3.64, p ＜ .001). In addition, BiPAP improved the dyspnea of patients more than the all-purpose nebulizer (Z = -2.65, p ＜ .01). Evaluation of the degree of distress symptoms revealed that the most uncomfortable distress symptoms are the mask being painful and a dry mouth, when using BiPAP and anxiety and dry mouth when using the all-purpose nebulizer mask. According to the overall distress symptom score, the average value for BiPAP was 20.61 ± 6.21 and for the all-purpose nebulizer mask was 8.81 ± 5.39. Both BiPAP and the all-purpose nebulizer mask can relieve dyspnea in patients, but BiPAP results in more serious distress symptoms. In the future, when clinical health care providers are choosing oxygen therapy for terminal cancer patients with dyspnea, they should provide individual care to minimize the effects of discomfort.

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