Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Respirology. 2012 Jan;17(1):108-13. doi: 10.1111/j.1440-1843.2011.02049.x.
Malnutrition is prevalent in hospitalized patients and causes systemic damage including effects on the respiratory and immune systems, as well as predisposing to infection and increasing postoperative complications and mortality. This study aimed to assess the impact of malnutrition on the rate of postoperative pulmonary complications, respiratory muscle strength and chest wall expansion in patients undergoing elective upper abdominal surgery.
Seventy-five consecutive candidates for upper abdominal surgery (39 in the malnourished group (MNG) and 36 in the control group (CG)) were enrolled in this prospective controlled cohort study. All patients were evaluated for nutritional status, respiratory muscle strength, chest wall expansion and lung function before surgery. Postoperative pulmonary complications (pneumonia, tracheobronchitis, atelectasis and acute respiratory failure) before discharge from hospital were also evaluated.
The MNG showed expiratory muscle weakness (MNG 65 ± 24 vs CG 82 ± 22 cm H(2) O; P < 0.001) and decreased chest wall expansion (P < 0.001), whereas inspiratory muscle strength and lung function were preserved (P > 0.05). The MNG also had a higher incidence of postoperative pulmonary complications compared with the CG (31% and 11%, respectively; P = 0.05). In addition, expiratory muscle weakness was correlated with BMI in the MNG (r = 0.43; P < 0.01). The association between malnutrition and expiratory muscle weakness increased the likelihood of postoperative pulmonary complications after upper abdominal surgery (P = 0.02).
These results show that malnutrition is associated with weakness of the expiratory muscles, decreased chest wall expansion and increased incidence of pulmonary complications in patients undergoing elective upper abdominal surgery.
营养不良在住院患者中很常见，会导致全身性损伤，包括对呼吸系统和免疫系统的影响，使患者易感染，并增加术后并发症和死亡率。本研究旨在评估营养不良对上腹部择期手术患者术后肺部并发症发生率、呼吸肌力量和胸壁扩张的影响。
本前瞻性对照队列研究纳入了 75 例连续接受上腹部手术的候选患者（营养不良组 39 例，对照组 36 例）。所有患者在术前均评估营养状况、呼吸肌力量、胸壁扩张和肺功能。还评估了术后肺部并发症（肺炎、气管支气管炎、肺不张和急性呼吸衰竭）。
营养不良组呼气肌力量较弱（营养不良组 65 ± 24 比对照组 82 ± 22 cm H₂O；P < 0.001），胸壁扩张减小（P < 0.001），而吸气肌力量和肺功能保持不变（P > 0.05）。与对照组相比，营养不良组术后肺部并发症发生率更高（分别为 31%和 11%；P = 0.05）。此外，营养不良组的呼气肌力量与 BMI 呈正相关（r = 0.43；P < 0.01）。营养不良与呼气肌无力的相关性增加了上腹部手术后肺部并发症的发生（P = 0.02）。
这些结果表明，营养不良与上腹部择期手术患者的呼气肌无力、胸壁扩张减小和肺部并发症发生率增加有关。
