慢性肺阻塞病人使用風扇可否改善自覺呼吸困難Can the use of fans in patients with Chronic Obstructive Pulmonary Disease improve conscious dyspnea?

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2020-03-22 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

陳家貞*

實證知識類別

B 類:實證健康照護應用

PICO

治療/預防性問題

治療/介入措施

胸腔暨重症加護醫學 Pulmonary and Critical Care Medicine

科別

  • 肺/胸腔護理 Pulmonary Nursing

中文關鍵詞

慢性肺阻塞疾病 風扇 呼吸困難

英文關鍵詞

Chronic Obstructive Pulmonary Disease COPD Fan Dyspnea

機構名稱

長庚醫療財團法人高雄長庚紀念醫院

申請單位

護理部

中文摘要

形成臨床提問:
慢性肺阻塞疾病(Chronic Obstructive Pulmonary Disease, COPD)是不可逆的呼吸道阻塞疾病,主要症狀為呼吸困難,病人常因此症狀身心受折磨,影響生活品質。呼吸困難是自覺的主觀感受,人體臉部具有上呼吸道接受體,主要由三叉神經支配,若針對臉部增加冷空氣,可以減少呼吸困難的強度及降低呼吸不適(Schwartzstein, 2019);臨床上除藥物治療可緩解呼吸困難外,在非藥物上的介入策略,是否可依循生理學呼吸機轉之知識,提供病人足夠的氣流,進而改善呼吸困難的自覺感受,故以實證方式探討使用風扇介入改善呼吸困難之成效。
文獻搜尋的方法與分析:
依據實證護理步驟,形成一個可回答的臨床問題,以「PICO」關鍵字P:Pulmonary Disease Chronic Obstructive、I:Fan Therapy、O:Aware Dyspnea,使用MeSH term檢索同義字,搜尋PubMed、Embase、華藝線上圖書館、臺灣博碩士論文系統、Cochrane library,限定以人類及SR of RCTs為主、語言為英文,初步搜尋出123篇文獻,刪除重覆文獻28篇,再排除與主題不符合之82篇,進行摘要閱讀,再刪除研究設計不符合後,餘2篇Systemic review系統性文獻。
文獻的品質評讀:
運用CASP Checklist:10 questions of a Systematic Review評讀工具嚴格評讀文獻。依據Oxford Centre(2011)研究證據力等級分類,此兩篇文章皆為Level 1。運用GRADE評分系統評析,在偏差評估中,因採取風扇介入無法隨機及盲化,且風扇使用的時間與方式不同,採取測量指標也不相同,故selection bias部分偏高而評為低到中等級,文獻結果說明介入風扇吹臉部5分鐘,可緩解病人自覺呼吸困難,然而統合收案研究量少,評析證據品質為「中」;而策略具效益且無風險建議強度分級為「強」。
證據之臨床應用:
依據文獻評讀結果,擬定介入措施為提供手持電風扇朝臉部吹5分鐘,風速及距離不限,介入時間為當病人主訴呼吸困難時,測量指標為呼吸困難數字評分量表(NRS),使用風扇5分鐘後再測量NRS相,若與第一次評估分數降低,則可持續使用使手持風扇,若NRS分數升高,則改進行常規處置。
成效評值:
實施期間共執行3週,收案15人,其呼吸困難數字量表(NRS)由介入前5.33分下降至介入後2.80分,顯示風扇吹臉對於緩解自覺呼吸困難具有顯著效應;而病人對於風扇改善呼吸困難整體滿意度為94.4%,具有良好滿意度。
結論與建議:
慢性肺阻塞病人使用風扇吹臉部可達到緩解自覺呼吸困難感受,風扇策略是一項安全且經濟實惠之措施,無傷害性、無特殊安全問題,對減輕焦慮感,增加身體活動程度,是極為可行之策略,以增進病人舒適程度,以提升生活品質。

英文摘要

Ask an answerable question (PICO):
Chronic Obstructive Pulmonary Disease (COPD) is an irreversible obstruction of the respiratory tract. The main symptom is dyspnea. Patients often suffer from physical and mental torture due to the symptoms, which directly affects the quality of life. Dyspnea is a conscious subjective feeling. The human face has an upper respiratory tract receiver, which is mainly dominated by the trigeminal nerve. If you use cold air on the face, it can reduce the intensity of dyspnea and reduce respiratory discomfort (Schwartzstein, 2019). In addition to drug therapy, dyspnea can be relieved if non-medical intervention strategies can be used to provide patients with sufficient airflow based on the knowledge of respiratory physiology, thereby relieving the feeling of dyspnea. An empirical method is used to explore the effect of fans on dyspnea by attempting to provide better airflow.
The Method and Analysis of Literature Review:
By forming an answerable clinical question based on empirical nursing steps and using "PICO" keywords P: Pulmonary Disease Chronic Obstructive, I: Fan Therapy, O: Aware Dyspnea, use MeSH term to search for synonyms on PubMed, Embase, Airiti Library, Taiwan Ph.D. Dissertation System, Cochrane Library, limited to people and SR of RCTs, in the English language. Initially, 123 articles were searched, 28 duplicate articles were deleted, and 82 articles were excluded for not matching the topic. After reading the abstract sections and deleting the study design nonconformities, 2 systematic reviews were remaining.
Critical Appraisal:
CASP Checklist: 10 questions of a Systematic Review review tool to critically review the literature. According to the Oxford Centre’s (2011) research on the level of evidence strength, these two articles are Level 2 and Level 1. The GRADE scoring system is used for evaluation. Deviation evaluation, due to the following reasons: fan intervention unable to be randomized and blinded, different time and methods of fan use, and different measurement indicators resulted in the selection bias being high and rated as low to medium. The literature results show that a fan blowing on the face for 5 minutes can alleviate the patient's conscious breathing difficulties. However, the number of integrated studies are small, and the quality of the evaluation evidence is "medium". The strategy is effective and risk-free.
Clinical Application of Evidence:
According to the literature review results, the intervention measures were proposed to provide a handheld electric fan for patients to blow on their face for 5 minutes. The wind speed and distance are not limited, and the intervention time is when the patient complains of dyspnea. The measurement index is the dyspnea digital score scale (NRS). After the patient uses the fan for 5 minutes, measure the NRS phase. If the score is lower than the first evaluation, the handheld fan can be used continuously. If the NRS score increased, the routine treatment should be performed instead.
Evaluation of Effectiveness:
During the implementation period, 15 cases were performed and collected over a total of 3 weeks. The NRS decreased from 5.33 points, before the intervention, to 2.80 points after the intervention, showing that the fan blowing the face has a significant effect on alleviating conscious breathing difficulties. The overall satisfaction with improvement in dyspnea was 94.4%, with good satisfaction.
Conclusions and Recommendations:
Patients with Chronic Obstructive Pulmonary Disease can use a fan to blow their face to alleviate feelings of breathing difficulties. The fan strategy is a safe and economical measure as it poses no harm nor special safety issues and is an extremely effective way to reduce anxiety thus increasing physical activity. It is one of the feasible strategies to improve patient comfort and quality of life.