Division of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand.
Eur J Cardiothorac Surg. 2010 May;37(5):1158-66. doi: 10.1016/j.ejcts.2009.12.011. Epub 2010 Feb 6.
This study investigates whether targeted postoperative respiratory physiotherapy decreased the incidence of postoperative pulmonary complications and length of stay for patients undergoing elective pulmonary resection via open thoracotomy.
Seventy-six patients participated in a prospective, single-blind, parallel-group, randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Treatment group participants received daily respiratory physiotherapy interventions until discharge. Control group participants received standard medical/nursing care involving a clinical pathway. The presence of postoperative pulmonary complications was assessed on a daily basis during hospitalisation using a standardised diagnostic tool. Length of stay was recorded.
Postoperative pulmonary complications developed in two participants (4.8%) in the treatment group and in one participant (2.9%) in the control group; the difference (treatment minus control) was 1.8% (95% confidence interval (CI) -10.6% to 13.1%) (p=1.00). No significant difference was found between groups for length of stay (treatment group, median 6.0 days; control group 6.0 days) (p=0.87). A preoperative forced expiratory volume in 1s of 1.5l or less (p=0.005) and a history of chronic obstructive pulmonary disease (p=0.008) were associated with a greater number of criteria for a postoperative pulmonary complication being met.
In this patient population, given the low incidence of postoperative pulmonary complications, targeted respiratory physiotherapy may not be required in addition to standard care involving a clinical pathway following pulmonary resection via open thoracotomy. These results should be extrapolated with caution to those patients undergoing pulmonary resection with poor preoperative lung function.
本研究旨在探讨针对术后呼吸物理疗法是否可以降低行开胸肺切除术的择期患者的术后肺部并发症发生率和住院时间。
76 名患者参与了一项前瞻性、单盲、平行组、随机试验，采用隐蔽分组、评估者盲法和意向治疗分析。治疗组患者接受每日呼吸物理治疗干预，直至出院。对照组患者接受标准的医疗/护理，包括临床路径。在住院期间，使用标准化诊断工具每天评估术后肺部并发症的发生情况。记录住院时间。
治疗组有 2 名（4.8%）患者和对照组有 1 名（2.9%）患者发生术后肺部并发症；差异（治疗组减去对照组）为 1.8%（95%置信区间（CI）-10.6%至 13.1%）（p=1.00）。两组的住院时间无显著差异（治疗组中位数为 6.0 天；对照组为 6.0 天）（p=0.87）。术前用力呼气量 1 秒（FEV1）小于或等于 1.5L（p=0.005）和慢性阻塞性肺疾病（COPD）病史（p=0.008）与更多的术后肺部并发症标准相符。
在本患者人群中，由于术后肺部并发症发生率较低，针对术后呼吸物理疗法可能不是必需的，标准护理包括开胸肺切除术后的临床路径。这些结果应谨慎推广至术前肺功能较差的肺切除术患者。
