呼吸器依賴患者的生活功能及生活品質

Purposes: In the present study, we evaluated the functional status and quality of life(QOL) in ventilator-dependent patients using standardized measurement tools. The reliability of these tools and relationships between them were also examined. Methods: Twenty-nine ventilator-dependent patients with clear consciousness at three respiratory care settings(respiratory care center, general wards of a medical center and a regional hospital, and respiratory care ward of a local hospital) were interviewed. Measurement tools employed in the interview process included the Barthel Index (BI) and Functional Independence Measure (FIM) for functional status measurement, and Short-Form 36 Items Health Survey (SF-36) for generic QOL assessments. Eighteen patients were interviewed twice in one-week period to measure the test-retest reliability. Results: The average age of the subjects was 73.5±11.5 years. Seventy percent of the patients were over 70 years old,45% of them had been using ventilator for more than half a year, and 52% of them had a chronic obstructive pulmonary disease (COPD).The results were as follows: The mean BI score was 2.1±3.9.The mean scores on the motor and cognitive domains of the FIM were 20.4±14.6 and 18.6±6.3,respectively.The mean scores on the physical and mental domains of the SF-36 were 21.5±7.6 and 42.0±10.3,respectively.Scores on FIM and SF-36were not significantly different across groups categorized by age, diagnosis, or duration on mechanical ventilator. The intra-class correlation coefficient(ICC)was 0.995 for BI,0.926 to 1.000 for FIM, and 0.874 to 1.000 for SF-36.The BI scores correlated significantly (p＜0.001) with FIM scores in motor domain(r=0.877)and total scores (r=0.729). No correlation was found between functional status measurements and QOL scores. Conclusion: This study was the first attempt to measure the functional status and QOL of ventilator-dependent patients in Taiwan. Their average scores of the functional status and QOL were relatively low, and were not associated with age, diagnosis, or duration on ventilator. Good test-retest reliability for BI, FIM, and SF-36 instruments was found. There appears no significant relationship between measurements of functional status and QOL in these patients.