| 摘要: | 阻塞型肺部疾病(COPD)在1990年時，已經在全球位居第六死因，隨著環境的污染跟變異，加上吸菸的盛行率增加；在2030年將會躍居變成全球第三的致死原因。COPD不僅僅只是簡單的肺部疾病，因為持續全身性的發炎反應會導致許多器官的損傷，產生許多相關的共病現象，比如：心血管疾病、骨質疏鬆、肺癌、糖尿病等的產生，而COPD產生骨質疏鬆的盛行率約50-70%。骨質疏鬆症是在無聲無息中慢慢發生，COPD患者本身因為疾病關係容易感到呼吸困難、呼吸喘導致活動量下降，最後會進而影響日常生活功能；若再加上骨質疏鬆的影響，骨折機會大增，一旦骨折情況產生，容易導致FEV1下降或者產生侷限型的肺部，這樣更容易使COPD病人病情惡化，導致呼吸喘、運動耐力不足、進而降低生活品質。因此本研究的目的主要探討慢性阻塞性肺疾病病患骨質疏鬆症與日常身體活動及活動時血氧飽和度的相關性。
本研究收案包含經醫師評估目前處於病情穩定狀態的COPD病患27位與健康的正常人6位。兩組均接受體位測量，IPAQ、CAT與骨質疏鬆生活品質量三種問卷訪談；訪談後衛教病患使用活動記錄器、脈衝式血氧飽和記錄器與如何填寫日常活動記錄表，記錄器佩帶24小時並配合記錄日常活動，回診後執行六分鐘走路測試。
研究結果顯示COPD患者24小時中，休息/坐的時間顯著多於正常人且身體活動的時間明顯較正常人少。在基本資料方面: 研究結果顯示抽煙量、CAT和FEV1與骨質密度有相關，而年齡與骨質密度沒有相關；身體組成與體位方面：研究結果顯示BMI、FFMI、臂中圍和小腿圍與骨質密度有相關。運動耐力方面只有六分鐘行走距離與骨質密度具相關性；骨質疏鬆生活品質量表總分、疼痛部分和生理部分與骨質密度有相關，而心理部分與骨質密度沒有相關。在日常生活功能與血氧飽和度方面: IPAQ、24小時活動頻率和24小時缺氧比率與骨質密度亦有相關。
本研究透過問卷評估、日常生活活動與血氧飽和度的監測，近一步瞭解COPD病患骨質疏鬆症與日常身體活動量減少及活動時血氧飽和度的不足有相關，期望此結果將可提供後續照護與衛教的參考，讓病患能注重日常身體活動的習慣與復原運動能及早介入，以避免骨質流失之危險因子並維持良好的健康。
Chronic obstructive pulmonary disease in 1990 has been ranked as the sixth leading cause of death in the world. All along the pollution of the environment with the variation and increasing prevalence of smoking. In 2030 will rise to become the world's third cause of death. COPD is not just a simple lung disease because sustained systemic inflammatory response can cause damage to many organs, resulting in a number of related Comorbidity. Such as cardiovascular disease, osteoporosis, cancer, diabetes et al, and the prevalence of osteoporosis in COPD produce approximately 50-70%. Osteoporosis was occurring slowly and silent, COPD patients themselves because of the disease likely to feel difficulty breathing and short of breath causes. Those’s decreased activity, and eventually turn affect activities of daily living .When coupled with the impact of osteoporosis, fractures opportunities increase. Once generated fractures, easily lead to decline in FEV1 or produce restrictive lungs, which make it easier for COPD with acute exacerbation. Resulting in dyspnea, exercise endurance inadequate, thereby reducing the quality of life.
The purpose of this study focuses on patients with COPD and osteoporosis correlation. Through daily physical activity monitoring, to analysis patient's activity patterns and oxygen saturation, and links with the bone mineral density.
Enrolled in this study include evaluation by a physician is currently in stable condition status of patients with COPD （27） and healthy normal （6）. Both groups received anthropometry, IPAQ, CAT and QUALEFFO-31 interviews; after interviews we teach patients to use actigraphy and pulse Oximetry .Then how to fill out the daily log sheets, the recorder worn 24 hours and with record daily activities, back to the clinic performed after six minutes walking test.
The results showed that in 24 hours to patients, the sitting longer than normal and moving less than normal. In the basic data: the study showed the amount of smoke, CAT and FEV1 are associated with bone mineral density, but no correlation between age and bone mineral density. Body composition and body position: the study showed BMI, FFMI, arm circumference , calf circumference and bone mineral density relevant. Exercise endurance is only six minutes walking distance and correlation with bone mineral density; Osteoporosis Quality of Life Scale total score, pain and physical part with some relevant bone mineral density, but the psychological part is not related to bone mineral density. An activity of daily living and SpO2, IPAQ, 24 hour activity frequency and 24-hour desaturation ratio was correlated with bone mineral density.
A questionnaire assessing the monitoring of activities of daily living, so that follow-up to provide health education, so that patients can focus on the habit of daily physical activity and rehabilitation for early intervention in order to avoid the risk factors of bone loss and maintain well health. |
