[[alternative]]Effects of Breathing Training on Psychophysiological Adaptation and Function in Patients with Acute Stroke

[[abstract]]本論文以系統性文回顧法，回顧呼吸訓練在腦血管意外事件之成效、並發展中風疾病早期病患適合執行之自主呼吸訓練方案後再進行臨床測試。研究目的:本研究旨在構建及評估自主呼吸訓練方案在生理參數，包括:心率變異性、 血壓、SpaO2、呼吸速率及自覺睡眠品質、日間疲憊、及腦中風疾病嚴重度量表(NIHSS)於介入前及介入後第一天、第三天、第五天、與第七天之效益；並驗證呼吸訓練方案在介入後，降低缺血性中風病人的焦慮、疲憊嚴重度以及改善神經性失能依賴(mRS)之成效。研究方法:本研究採雙組、重複測量研究設計。在北部某醫學中心神經內科所屬病房，於100年12月2日至103年10月8日進行收案，最後收計有效樣本實驗組32人、對照組41人，總樣本數73人，以單變量統計及廣義估計方程式模式進行成效假設應證。介入處置:實驗組受試者除例行的常規復健外，再接受合併有研究者面對面訪視指導、以及自我練習的蹶嘴呼吸訓練(PLB)方案，總計七天。練習時間每天3-5次，每次練習時間10分鐘。對照組接受例行的常規復健。研究結果: (一)接受呼吸訓練的實驗組病患在心率變異性、SpaO2、呼吸速率等變項與第一天前測基準值比較時，都呈現顯著改善效果。例如: 顯著下降的平均心跳在實驗組第三天(p=0.019)；顯著升高的SDNN在實驗組第一天及第三天(p= 0.033, p<0 .0001)；明顯隨時間改變升高的ln(LF) 在實驗組第一、三、五、七天(p<0.0001, p<0.0001, p=0.002, p=0.026)；顯著上升的ln(HF)在實驗組第一天(p= 0.001)；明顯上升的LF(%)在實驗組第一天、第三天、第五天(p= 0.001, p= 0.026, p= 0.001)；顯著升高的LF/HF(%)在實驗組第一天、第三天、第五天(p< 0.001, p= 0.024, p< 0.001)；以及顯著回升的SpaO2 在實驗組第一天(p=0.015)；明顯隨時間下降的呼吸次數在實驗組第一、三、五、七天 (p<0.0001, p<0.0001, p<0.0001, p<0.0001)。(二)校正共變項後，實驗組SBP隨時間顯著下降在呼吸訓練後第一天，但第三、五、七天下降改變未達統計顯著差異(p<0.0001, p=0.744, p=0.409, p=0.319)；實驗組DBP明顯隨時間升高在呼吸訓練後第一天及第三天(p=0.009, p<0.0001, p=0.236, p=0.959)。(三)實驗組日間嗜睡分數隨時間顯著改善，訓練後第一天達統計顯著差異(p<0.0001, p=0.744, p=0.409, p=0.319)。(四)實驗組腦中風疾病嚴重度(NIHSS)分數隨時間顯著改善，在訓練後第七天達統計顯著差異(p=0.617, p=0.091, p<0.0001)。(五)二組後測焦慮分數顯著改善，校正時間與前測焦慮值後，達統計顯著差異(p=0.021)。二組後測疲憊嚴重度顯著改善，校正後達統計顯著差異(p=0.045)。二組後測神經性失能依賴(mRS)分數顯著改善，校正時間後，達統計顯著差異(p=0.01)。結論: 以上研究結果顯示，七天呼吸訓練方案能穩定生理參數、促進心理適應與神經功能復原。建議急性腦中風病人住院早期就應開始進行呼吸訓練，未來研究可擴大此呼吸訓練方案的執行對象到神經疾病或其他疾病族群，檢測方案的長期利益及中樞效應。[[abstract]]AimThis study aimed to construct and evaluate the effects of breathing training protocol on psychophysiological parameters (heart rate variability, blood pressure, SpaO2, and respiratory rate) as well as sleep quality, daytime drowsy and NIHSS scores during pre-intervention (Day1 pre) and post-intervention days (Day1, Day3, Day5, and Day7) and determined whether breathing training could lower the anxiety, and the fatigue severity scores during post-intervention Day 7 as well as whether breathing training could improve neurologic disability(mRS) during post-intervention Day 7 in patients with acute ischemic stroke.Methods This was a two group repeated measures research design for 73 subjects aged 42~94 years who were diagnosed acute ischemic stroke with stroke onset time over 48 hour. Data were collected from December, 2011 to October, 2014. Subjects were assigned to either a breathing training group (n=41) or a control group received routine stroke rehabilitation program (n=32). Generalized estimating equation analysis was used to compare groups.Intervention7 days combined coaching and self-practice pursed lips breathing training program (PLB), 3-5 times per day, total 10 minutes per session.ResultsFirstly, significant improvements of heart rate variability, SpaO2, and respiratory rates were shown in the experimental group after receiving the breathing training in specific testing day, i.e. decreased mean heart rate in Day3 (p=.019), increased SDNN in Day1, and Day3 (p=.033, p<.0001), elevated ln(LF) in Day1, Day3, Day5, and Day7 (p<.0001, p<.0001, p=.002, p=.026), increased ln(HF) in Day1 (p=.001), elevated LF(%) in Day1, Day3, and Day5 (p=.001, p=.026, p=.001), increased LF/HF ratio in Day1, Day3, and Day5 (p<.0001, p=.024, p<.0001), increased SpaO2 in Day1(p=.015), and lowered respiratory rates in Day1, Day3, Day5, and Day7 (p<.0001, p<.0001, p<.0001, p<.0001) compared with baseline, respectively.The SBP value was significantly decreased over-time between groups in Day1 (p<.0001, p=.744, p=.409, p=.319), the DBP value was significantly increased over-time between groups in Day1 and Day3 (p=.009, p<.0001, p=.236, p=.959), the daytime drowsy score was significantly improved over-time between groups in Day1 (p<.0001, p=.744, p=.409, p=.319), the NIHSS score was significantly improved over-time between groups in Day7 (p=.617, p=.091, p<.0001) compared with baseline, respectively. Secondly, there was a siginificantly improved on the anxiety score (p=.021), the fatigue severity score (p=.045), and the neurologic disability (p=.01) during post-intervention Day 7 in patients with acute ischemic stroke. ConclusionThese results revealed the 7-day breathing training program stabilized some physiological parameters, promoted psychological adaptation and neurological function recovery in patients with acute ischemic stroke. Thus, acute stroke inpatients are recommended for breathing training. Futue studies might implement this breathing training program and evaluate the central effects in brain as well as long-term benefits in population with neurological diseases or other illness