Borghi-Silva Audrey, Mendes Renata Gonçalves, Costa Fernando de Souza Melo, Di Lorenzo Valéria Amorim Pires, Oliveira Claudio Ricardo de, Luzzi Sérgio
Cardiology Unit, Santa Casa de Misericórdia de Araraquara.
Clinics (Sao Paulo). 2005 Dec;60(6):465-72. doi: 10.1590/s1807-59322005000600007. Epub 2005 Dec 12.
To evaluate the effects of positive end expiratory pressure and physiotherapy intervention during Phase I of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery.
A prospective randomized study, in which 24 patients were divided in 2 groups: a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention (GEP, n = 8) and a group that received only the physiotherapy intervention (GPI, n = 16). Pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days.
Spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the GPI, while the GEP had a significant reduction only for vital capacity (P < .05). When the treatments were compared, smaller values were observed in the GPI for peak flow on the fifth postoperative day. Significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups. However, the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the GPI (P < .05).
These data suggest that cardiac surgery produces a reduction in inspiratory muscle strength, pulmonary volume, and flow. The association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes, in comparison to the physiotherapy intervention alone. However, in both groups, the pulmonary volumes were not completely reestablished by the fifth postoperative day, and it was necessary to continue the treatment after hospital convalescence.
评估心脏康复第一阶段呼气末正压通气和物理治疗干预对心脏手术后肺功能和吸气肌力量的影响。
一项前瞻性随机研究，将24例患者分为两组：一组进行呼气末正压通气联合物理治疗干预的呼吸锻炼（GEP组，n = 8），另一组仅接受物理治疗干预（GPI组，n = 16）。术前及术后第5天通过肺活量测定评估肺功能；同一天通过最大吸气压测量吸气肌力量。
GPI组从术前到术后第5天，肺量计变量显著降低，而GEP组仅肺活量有显著降低（P < 0.05）。比较两组治疗时，术后第5天GPI组的峰值流速值较小。两组从术前到术后第1天最大吸气压均显著降低。然而，从术前到术后第5天最大吸气压的降低仅在GPI组显著（P < 0.05）。
这些数据表明心脏手术会导致吸气肌力量、肺容量和流速降低。与单纯物理治疗干预相比，呼气末正压通气联合物理治疗干预在最小化这些变化方面更有效。然而，两组术后第5天肺容量均未完全恢复，出院康复后仍需继续治疗。
