心臟復健運動對心瓣膜置換病患日常活動進展之探討

　　　　　心臟復健運動雖然已在國外推展多年且成果斐然，但目前國內臨床上，有關心瓣膜疾病患者之心臟復健運動計劃之研究仍相當有限。本研究的目的在探討心臟復健運動計劃對協助心瓣膜置換病患，早日恢復自我照顧及執行日常活動的能力的影響。 本研究採準實驗法，依選樣條件選取50名心瓣膜置換病患，隨機分派至實驗組及對照組各25名。實驗組病患住院期間接受「心臟復健運動方案」訓練，以協助執行日常活動，對照組病患則完全依其個人需要操作日常活動。兩組病患於住院期間，出院後第一週、一個月、二個月、三個月回院複診時，接受問卷會談，以追蹤其日常活動進展狀況。 本研究統計資料分析採用卡方檢定、t－test檢定、重覆測量之變異數分析、Ducans test，研究結果顯示：（1）實驗組病患平均於術後1.6天開始執行心臟復健運動計劃，約6天可完成。（2）實驗組病患住院期間達2.5METs及3.0METs日常活動量所需的日數均比對照組為短。（3）實驗組病患的日常活動完成率比對照組高，費力症狀出現率比對照組低。（4）實驗組病患住院期間延後執行日常活動的人數，較對照組少。（5）實驗組病患出院前達3.5METs最高日常活動量的人數較對照組顯著的多。（6）實驗組病患出院後第一週、一個月、二個月、三個月的日常活動量進展均較對照組高。 本研究結果可提供臨床護理人員協助心瓣膜置換病患執行心臟復健運動實之準則。
　　　　　Cardiac rehabilitation programs (CRP) have been developed for many years and the effectiveness of CRP is also demonstrated. However, current research on cardiac rehabilitation program for the patients with valve disease is still limited in our country. The purpose of this study was to investigate the effects of the CRP on improving self-care and the progress of the activities of daily living to the patients with valve replacement. A Quasi-experimental design was conducted in this study. Fifty patients with valve replacement who met the inclusion criteria were selected and were divided into the experimental (N=25) and control (N=25) groups. An intervention under CRP guidance to improve the activities of daily living was given to the experimental group. The control group performed the activities of daily living based on their needs without the guidance of CPR. The progress of activities of daily living was measured by face to face interview during hospitalization and at the first week, first month, second month, and third month after discharge from the hospital. Data were analyzed using Chi-square, t-test, Repeated measure ANOVA, and Duncans test. The results indicated that; (1) In experimental group, patient began the CRP within 1.6 days after operation, and accomplished CRP within 6 days. (2) In experimental group, length of day to perform the daily activities of 2.5 METs and 3.0 METs was shorter than control group. (3) In experimental group, the rate of accomplishment of activities of daily living was more than control group, and the rate of accompanied exertion symptoms was less than control group. (4) In experimental group, the rate of delay to perform activities of daily living was less than control group. (5) There was a significant difference between two groups in the daily activities of 3.5 METs during hospitalization. (6) There was a significant difference between two groups in the progress of daily activities at the first week, first month, second month, and third month after discharge from the hospital. This finding of this study may offer an guidance for the clinical staff to assist patients with valve replacement to perform CRP.