State University of Rio de Janeiro, Brazil.
Respir Care. 2012 Mar;57(3):363-9. doi: 10.4187/respcare.01267. Epub 2011 Sep 26.
The application of CPAP has been used to minimize postoperative pulmonary complications after lung resection surgery. The aim of this study was to quantify both the CPAP effects upon lung function and functional capacity in early postoperative lung resection, as well as to evaluate if CPAP prolongs air leak through the chest drain.
Thirty patients in the postoperative period of lung resection were allocated into 2 groups: an experimental group, consisting of 15 patients who underwent a 10 cm H(2)O CPAP, and a 15 patient control group, who performed breathing exercises. Arterial blood gas analysis, peak expiratory flow (PEF), respiratory muscle strength, spirometry, and 6-min walk test (6MWT) were assessed in the preoperative period, and repeated postoperatively on the first and on the seventh day (6MWT was repeated only on the seventh day).
Significant increases in PEF, muscle strength, and FEV(1) between the first and seventh postoperative day were observed, both in the experimental and in the control group, whereas FVC and P(aO(2)) increased significantly between the first and seventh postoperative day only in the experimental group. The average loss in 6-min walk distance (6MWD) from preoperative to postoperative day 7 in the experimental group was significantly lower than in control group. When comparing the 2 groups, only 6MWD was statistically different (P < .001). There was no air leakage increase through the drain with the early use of CPAP.
When compared to breathing exercises, CPAP increases the 6MWD in postoperative lung resection patients, without prolonging air leak through the chest drain.
CPAP 的应用已被用于最大限度地减少肺切除术后的肺部并发症。本研究的目的是量化 CPAP 对肺切除术后早期肺功能和功能能力的影响,并评估 CPAP 是否会延长通过胸腔引流管的漏气。
将 30 例肺切除术后患者分为 2 组:实验组 15 例,行 10cmH2O CPAP;对照组 15 例,行呼吸锻炼。在术前评估动脉血气分析、呼气峰流速(PEF)、呼吸肌力量、肺量计和 6 分钟步行试验(6MWT),并在术后第 1 天和第 7 天重复评估(仅在第 7 天重复 6MWT)。
实验组和对照组在术后第 1 天和第 7 天之间,PEF、肌肉力量和 FEV1 均显著增加,而 FVC 和 P(aO2)仅在实验组中在术后第 1 天和第 7 天之间显著增加。实验组从术前到术后第 7 天的 6 分钟步行距离(6MWD)平均损失明显低于对照组。比较两组时,仅 6MWD 具有统计学差异(P<0.001)。早期使用 CPAP 并没有增加引流管的漏气。
与呼吸锻炼相比,CPAP 可增加肺切除术后患者的 6MWD,而不会延长胸腔引流管的漏气。