Department of Physiotherapy, Austin Hospital, Heidelberg, Victoria, Australia.
Physiotherapy. 2013 Jun;99(2):119-25. doi: 10.1016/j.physio.2012.05.013. Epub 2012 Sep 23.
Previous Australian studies reported that postoperative pulmonary complications affect 13% of patients undergoing upper abdominal laparotomy. This study measured the incidence of postoperative pulmonary complications, risk factors for the diagnosis of postoperative pulmonary complications and barriers to physiotherapy mobilisation in a cohort of patients undergoing high-risk abdominal surgery.
Prospective, observational cohort study.
Two surgical wards in a tertiary Australian hospital.
Seventy-two patients undergoing high-risk abdominal surgery (participants in a larger trial evaluating a novel model of medical co-management).
Incidence of, and risk factors for, postoperative pulmonary complications, barriers to mobilisation and length of stay.
The incidence of postoperative pulmonary complications was 39%. Incision type and time to mobilise away from the bed were independently associated with a diagnosis of postoperative pulmonary complications. Patients were 3.0 (95% confidence interval 1.2 to 8.0) times more likely to develop a postoperative pulmonary complication for each postoperative day they did not mobilise away from the bed. Fifty-two percent of patients had a barrier to mobilisation away from the bed on the first postoperative day, with the most common barrier being hypotension, although cessation criteria were not defined objectively by physiotherapists. Development of a postoperative pulmonary complication increased median hospital length of stay (16 vs 13 days; P=0.046).
This study demonstrated an association between delayed postoperative mobilisation and postoperative pulmonary complications. Randomised controlled trials are required to test the role of early mobilisation in preventing postoperative pulmonary complications in patients undergoing high-risk upper abdominal surgery.
先前的澳大利亚研究报告称，术后肺部并发症影响 13%接受上腹部剖腹手术的患者。本研究测量了术后肺部并发症的发生率、术后肺部并发症诊断的危险因素以及高危腹部手术后患者进行物理治疗活动的障碍因素。
前瞻性观察队列研究。
澳大利亚一家三级医院的两个外科病房。
72 名接受高危腹部手术的患者（参加评估一种新型医疗联合管理模型的更大规模试验的参与者）。
术后肺部并发症的发生率、危险因素、活动障碍因素和住院时间。
术后肺部并发症的发生率为 39%。切口类型和离开床旁开始活动的时间与术后肺部并发症的诊断独立相关。患者每多一天未离开床旁活动，发生术后肺部并发症的可能性就增加 3.0 倍（95%置信区间 1.2 至 8.0）。52%的患者在术后第 1 天存在离开床旁活动的障碍，最常见的障碍是低血压，尽管物理治疗师并未客观地定义停止活动的标准。发生术后肺部并发症会增加住院中位数（16 天 vs. 13 天；P=0.046）。
本研究表明术后活动延迟与术后肺部并发症之间存在关联。需要进行随机对照试验来检验高危上腹部手术后早期活动预防术后肺部并发症的作用。
