六分鐘步行對心衰竭病人疲憊及生理指標之初探

A Preliminary Study on the Fatigue and Physiological Indexes of Patients with Heart Failure for Six-Minutes Walks

謝佳珍

心衰竭 ； 六分鐘步行 ； 疲憊 ； 生理指標 ； Heart failure ； Six-Minutes Walks ； fatigue ； Physiological Indexes

高雄醫學大學護理學系碩士班學位論文

2018年

碩士

吳麗敏

繁體中文

背景: 心衰竭是臨床綜合症候群，病人因呼吸困難、疲憊等症狀 影響身體功能造成病人自我活動限制及不能、影響生活品質，增加家 庭負荷及國家高健保負擔，在國內、外，心衰竭都是重要不容忽視的 高死亡率的慢性病，因此想瞭解六分鐘步行運動對於心衰竭病患的成 效。 研究目的:探討心衰竭病人接受六分鐘走路運動對疲憊之成效， 以及六分鐘走路運動對生理指標(血氧、心跳、收縮壓、舒張壓)之 影響和接受六分鐘走路運動的滿意程度。 研究方法:為重複測量單組之類實驗性研究，於南部某醫學中心 心臟科收集，依納入及排出條件篩選個案，經研究者向病人解釋本研 究目的、操作方式、執行研究後的效益和可能存在的風險。病人簽署 參加研究同意後，才進行六分鐘走路。施測前，由研究者協助個案填 寫FACIT 疲憊量表(第四版)。在個案服藥後30 分鐘後且固定於下午 時間陪同六分鐘走路運動，持續六分鐘步行。介入措施共施測五次， 每次於步行前、步行後、步行後2 分鐘監測病人的生理指標(血氧、 收縮壓、舒張壓、心跳)。問卷(FACIT 疲憊量表，第四版)、滿意度問 卷調查填寫於介入措施前和第五次介入後。 結果:心衰竭病人接受六分鐘走路運動後疲憊呈現顯著改善，在 接受六分鐘步行運動休息2 分鐘後，血氧、收縮壓在第二次出現明顯 差異，但是在第3 次、第4 次和第5 次均無顯著差異，但是舒張壓、 心跳均無顯著性改變。94.9%心衰竭病患表示睡眠改善.，92.3%表示 有助益，94.9%對於六分鐘走路運動表示滿意。 結論與應用:持續的運動可以改善病人的疲憊感和增加睡眠品質。 提供醫療團隊於臨床推行6 分鐘步行運動，可以破除迷失，在專業人 員的陪伴下建立信心及運動習慣，病友家屬學會注意運動時的安全， 並持續養成習慣，延續未來的長期照護及與出院前作完整的規劃，對 病人、家庭、社會及醫療都是雙贏的局面。 因此六分鐘走路對心衰竭病患，是不具壓力，是一個安全的，可 以承受的運動。雖第二次運動的過程當中，血氧變異比較大，需提醒 家屬和病患執行運動時要有人陪伴，特別是第一次運動的病患要持續 且至少5 次以上，才能達到減緩疲憊和改善睡眠。

Background: Heart failure is a clinical syndrome. Due to dyspnea, fatigue and other symptoms, these affect patients’ physical functions and restrictions, influence quality of life, and increase family burdens and national health insurances. No matter domestic or foreign countries, heart failure is an important chronic disease with high mortality that cannot be ignored. Hence my research is to understand the effects of six-minute walking among heart failure patients. Objectives: To investigate the effect of six-minute walking exercise on fatigue, and physiological indices (spO2, heart rate, systolic pressure, diastolic pressure) and satisfaction with walking six minutes. Research Methods: It was a repeat, one group, quasi-experimental study. We approached participants from the cardiology department of a medical center in the south hospital, and recruited according to inclusion and exclusion criterions. The researcher explained the purpose of the study, and the benefits and possible risks after performing the study. After the patient signed the study consent, then the study was performed. Before the test, the FACIT Weary Scale (fourth edition) was filled in by participants. They routinely performed six-minute walking exercise in the afternoon after 30 minutes of taking medicines. Physical index were measured five times, and each for before, after, and after 2 min. walking. Questionnaire were contained FACIT Weary Scale, (Fourth Edition), and satisfaction questionnaire was filled in before the intervention and after the fifth intervention. Results: Heart failure patients showed significant improvement on fatigue after six minutes of walking exercise. After two minutes of six-minute walking rest, blood oxygenation and systolic blood pressure were significantly different for the second times. However, at the third, fourth and fifth times did not reported significant differences. 94. 9% of patients with heart failure said sleep improvement, 92.3% said helpful, 94.9% satisfied with six-minute walking exercise. Conclusions and applications: How we assess how we encourage patients and their families to get out of bed when we care, what we evaluate, and the variability we may encounter with physiologic indicators. The results of this study tell us that tiny vital signs Changes in the clinical is not significant, for colleagues and heart failure patients to further understand that continuous exercise can improve the patient's fatigue and improve sleep quality. To provide the medical team with a 6-minute walk in the clinic to get rid of the loss, establish confidence and exercise habits with the help of professionals, and learn to pay attention to the safety during exercise and continue to develop long-term Care and complete planning prior to discharge are a win-win situation for patients, families, the community and healthcare. So six minutes walking on patients with heart failure is not stressful and is a safe and affordable exercise. Although the process of the second exercise, blood oxygen variation is relatively large, remind family members and patients to be accompanied by exercise, especially in the first exercise to continue and at least 5 times in order to achieve the purpose of alleviating fatigue and improve sleeping.

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