Melendez J A, Alagesan R, Reinsel R, Weissman C, Burt M
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10023.
Chest. 1992 Feb;101(2):432-6. doi: 10.1378/chest.101.2.432.
We undertook this study to characterize the postthoracotomy compartmental displacement and respiratory mechanical changes occurring during and after the performance of the incentive spirometry maneuver. We also evaluated the effect of recumbency angle on compartmental recruitment. Sixteen patients were randomized to perform incentive spirometry either at 30 degrees or 60 degrees recumbency angle. They were studied using respiratory inductance plethysmography to measure tidal volume, respiratory frequency, inspiratory time, rib cage motion/tidal volume ratio, inspiratory duty cycle, and inspiratory flow. Patients were studied before surgery and on postoperative days 1 and 3. Statistical analysis was accomplished using multiple measures ANOVA with post-hoc Student's t-tests when appropriate. Preoperative incentive spirometry augmented VT by increasing both VT/TI and TI. Postoperatively, the incentive recruitment of VT was reduced, a result of a decrease in TI and TI/TTOT; VT/TI was unchanged. There was postoperative decrease of AB and AB/VT during incentive spirometry, greatest in the 60 degrees group. Our results characterize the nature of the respiratory recruitment afforded by incentive spirometry, before and after thoracotomy. We also found evidence of postthoracotomy diaphragmatic derecruitment during incentive spirometry exacerbated by a high recumbency angle.
我们开展这项研究，以描述在进行激励肺活量测定操作期间及之后发生的开胸术后胸腔内各腔室移位及呼吸力学变化。我们还评估了卧位角度对各腔室复张的影响。16例患者被随机分为在30度或60度卧位角度下进行激励肺活量测定。使用呼吸感应体积描记法对他们进行研究，以测量潮气量、呼吸频率、吸气时间、胸廓运动/潮气量比值、吸气占空比和吸气流量。在手术前以及术后第1天和第3天对患者进行研究。在适当情况下，使用多因素方差分析及事后学生t检验进行统计分析。术前激励肺活量测定通过增加VT/TI和TI来增加VT。术后，由于TI和TI/TTOT降低，VT的激励复张减少；VT/TI保持不变。在激励肺活量测定期间，AB和AB/VT术后降低，在60度组中最为明显。我们的结果描述了开胸术前和术后激励肺活量测定所带来的呼吸复张的性质。我们还发现有证据表明，在激励肺活量测定期间，高卧位角度会加剧开胸术后膈肌复张不足。
