Department of Thoracic Surgery, Hospital da Criança Santo Antônio/Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Respir Care. 2013 May;58(5):805-9. doi: 10.4187/respcare.01870.
Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary.
This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pediatric subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H2O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery.
The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P = .01). Subjects in the control group were more likely than those in the intervention group to require fiberoptic bronchoscopy for bronchial toilet (n = 14 [19.7%] vs n = 5 [9.6%], P ≤ .001). There was no difference in the time of drainage or hospital stay between the groups.
Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay.
早期物理治疗可减少成人患者肺切除术后的肺部并发症。然而，儿童肺切除术后术后物理治疗的效果和技术尚未得到很好的描述。因此，有必要对儿童肺切除术后的物理治疗进行标准化。
这是一项回顾性和前瞻性、干预性、描述性和定量研究。我们评估了 123 例接受肺切除术的儿科患者。52 例患儿前瞻性地接受了标准化的物理治疗方案，包括使用 10cmH2O 呼气正压面罩、呼气胸廓压缩、咳嗽、抬起上肢和走动，术后 4 小时内开始，每天进行 3 次。71 例接受了无特定标准化的物理治疗技术的历史对照组，并且在开始日期和治疗天数方面存在差异。我们记录了术后并发症、持续性肺漏气、术后支气管镜检查、胸腔引流管拔除时间和术后住院时间。
接受标准化物理治疗方案的组发生肺不张的比例低于对照组（15.4%比 7.6%，P =.01）。对照组中需要纤维支气管镜支气管灌洗的患者比干预组多（14 例[19.7%]比 5 例[9.6%]，P ≤.001）。两组引流时间或住院时间无差异。
在儿童肺切除术后实施标准化的物理治疗方案可减少肺不张，但不能减少引流管拔除时间或住院时间。
