2010-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645949摘要：背景及目的：吸氣肌肌力下降會造成肺泡通氣不足及肺葉塌陷，吐氣肌無力會造成氣道清潔維持困難，此兩個因素都會造成慢性呼吸不足並有可能導致致命如肺炎等後遺症。此外，呼吸肌功能與執行身體活動有密切的關連。在肺癌患者呼吸肌肌力變化及不同治療對其之影響尚無相關研究報告。本研究第一階段的主要目的主要是探討晚期肺癌患者（advanced stage）其呼吸肌功能與呼吸困難、生活功能、生活品質、6及12個月內呼吸系統併發症發病率及存活狀態之相關性（控制組）。第二階段研究將針對同類患者在進行癌症相關治療前給予胸腔復健衛教，並探討其成效（介入組）。方法：兩部分研究預計於臺大醫院徵收各102位晚期肺癌患者進行本研究。排除條件為有臨床診斷會影響呼吸肌表現測試者。受試者簽署同意書後，將進行以下參數測量包括：臨床表徵、疼痛指數、呼吸困難指數、呼吸肌功能（最大吸氣壓力、最大吐氣壓力、第一秒用力吐氣量、及用力呼氣肺活量）、功能活動能力（Karnofsky氏體能表現狀態及Simmonds氏功能評估量表）、醫院焦慮憂鬱量表（Hospital anxiety and depression scale）、及生活品質（European Organization for Research and Treatment of Cancer, EORTC QLQ-C30及LC13）評量。並於之後每個月門診，進行上述所有評量。此外，以追蹤方式紀錄其6及12個月內呼吸系統併發症發生率與存活狀態。第二階段受試者在癌症相關治療開始前，給予內容為維持氣道清潔及改善呼吸困難之胸腔物理治療衛教，後續測量時間點及項目同第一部份研究。對於非連續及連續性之參數，分別以卡方檢定（chi-square test）及獨立t檢定（independent t test）作為判斷兩組間是否具顯著差異之工具；以雙因子重覆變異數分析（two-way repeated ANOVA）來檢定不同測試時間點兩組間相關參數是否具顯著組間及組內差異，配合Bonferroni檢定進行事後分析（post-hoc test）。以史匹曼相關系數或爾森相關系數分析（Spearman or Pearson’s Correlation coefficient）參數之間的相關性。以多元迴歸分析（multiple stepwise regression analysis）探討呼影響患者呼吸系統併發症發病率、生活功能及品質的預測相關參數。顯著統計意義有效水平標準α訂為0.05。臨床重要性：肺癌患者有逐年增加的趨勢。瞭解胸腔物理治療介入的適應症（例如呼吸肌無力及其相關不良後果）及胸腔物理治療衛教介入對此類患者的療效，對於患者在接受癌症相關治療時，是否需常規介入胸腔物理治療具臨床參考價值。<br> Abstract: Background and Purpose: Respiratory muscle function is critical for maintaining effective alveolar ventilation, and airway secretions clearance. The reduction in respiratory muscle function might lead to chronic respiratory insufficiency, and potentially to life-threatening problems. Respiratory muscle function and the impacts of various treatments regimens have not been investigated longitudinally in patients with advanced lung cancer patients. The purposes for the 1st phase of this study are to exam longitudinal changes and the impact of various treatments on the respiratory muscle function, and the relations with dyspnea, functional capacity, quality of life, 6- and 12-month respiratory morbidity, and survival status (control group). The 2nd phase of this study will investigate the potential beneficial effects of chest physiotherapy in the same patient population (intervention group). Methods: 102 patients with advanced lung cancer per group will be recruited from the National Taiwan University Hospital. Demographic and clinical signs/syndromes will be obtained from the chart. Pain and dyspnea will be measured using visual analog scale. Respiratory muscle strength will be tested by measuring maximal inspiratory and expiratory pressure (PImax and PEmax, respectively). Spirometric variables, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) will be measured. Functional capacity will be measured using Karnofsky performance status and Simmonds functional assessment. Anxiety/depression symptom will be measured using Hospital Anxiety and Depression Scale. Quality of life will be measured using European Organization for Research and Treatment of Cancer, EORTC QLQ-C30 and LC13 questionnaire. Six- and 12-month respiratory complication morbidity and survival status will be recorded in the prospective nature. Two-way repeated ANOVA will be used to exam between and within groups differences across different time points. Bonferroni t-test will be used as the Post-hoc procedures. Spearman’s and Pearson correlation coefficient will be used to test the relationship between respiratory muscle function and multiple variables. Univariate and stepwise multiple regression analyses will be used to identify factors associated with functional capacity, respiratory complication morbidity and quality of life rate in patients with advanced lung cancer. The criteria for statistical significance will be taken as p<0.05. Clinical relevance: The prevalence of lung cancer is increasing in the recent years. To understand the indications for chest physiotherapy (e.g., respiratory muscle weakness and its related sequels) and the effects of chest physiotherapy program will shed light on if routine chest physiotherapy should be implanted for patients with advanced lung cancer during treatment.