肺切除术后激励式肺量计通气：一项随机对照试验。

Incentive Spirometry After Lung Resection: A Randomized Controlled Trial.

机构信息

Division of Thoracic Surgery, McMaster University, Hamilton, Canada.

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.

出版信息

Ann Thorac Surg. 2018 Aug;106(2):340-345. doi: 10.1016/j.athoracsur.2018.03.051. Epub 2018 Apr 24.

DOI:10.1016/j.athoracsur.2018.03.051

PMID:29702071

Abstract

BACKGROUND

Incentive spirometry (IS) is thought to reduce the incidence of postoperative pulmonary complications (PPC) after lung resection. We sought to determine whether the addition of IS to routine physiotherapy following lung resection results in a lower rate of PPC, as compared with physiotherapy alone.

METHODS

A single-blind prospective randomized controlled trial was conducted in adults undergoing lung resection. Individuals with previous lung surgery or home oxygen were excluded. Participants randomized to the control arm (PHY) received routine physiotherapy alone (deep breathing, ambulation and shoulder exercises). Those randomized to the intervention arm (PHY/IS) received IS in addition to routine physiotherapy. The trial was powered to detect a 10% difference in the rate of PPC (β = 80%). Student's t test and chi-square were utilized for continuous and categorical variables, respectively, with a significance level of p = 0.05.

RESULTS

A total of 387 participants (n = 195 PHY/IS; n = 192 PHY) were randomized between 2014 and 2017. Baseline characteristics were comparable for both arms. The majority of patients underwent a pulmonary lobectomy (PHY/IS = 59.5%, PHY = 61.0%; p = 0.84), with no difference in the rates of minimally invasive and open procedures. There were no differences in the incidence of PPC at 30 days postoperatively (PHY/IS = 12.3%, PHY = 13.0%; p = 0.88). There were no differences in rates of pneumonia (PHY/IS = 4.6%, PHY = 7.8%; p = 0.21), mechanical ventilation (PHY/IS = 2.1%, PHY = 1.0%; p = 0.41), home oxygen (PHY/IS = 13.8%, PHY = 14.6%; p = 0.89), hospital length of stay (PHY/IS = 4 days, PHY = 4 days; p = 0.34), or rate of readmission to hospital (PHY/IS = 10.3%, PHY = 9.9%; p = 1.00).

CONCLUSIONS

The addition of IS to routine postoperative physiotherapy does not reduce the incidence of PPC after lung resection.

摘要

背景

激励式呼吸法（IS）被认为可以降低肺切除术后肺部并发症（PPC）的发生率。我们旨在确定与单独进行物理治疗相比，肺切除术后加用 IS 是否会降低 PPC 的发生率。

方法

对接受肺切除术的成年人进行了一项单盲前瞻性随机对照试验。排除既往有肺手术或家庭吸氧的患者。随机分配到对照组（PHY）的患者仅接受常规物理治疗（深呼吸、走动和肩部运动）。随机分配到干预组（PHY/IS）的患者在常规物理治疗的基础上接受 IS。该试验的检测效能为检测 PPC 发生率降低 10%（β=80%）。使用学生 t 检验和卡方检验分别对连续变量和分类变量进行分析，显著性水平为 p=0.05。

结果

共有 387 名患者（n=195 PHY/IS；n=192 PHY）于 2014 年至 2017 年期间被随机分组。两组的基线特征相似。大多数患者接受了肺叶切除术（PHY/IS=59.5%，PHY=61.0%；p=0.84），微创和开放手术的比例无差异。术后 30 天 PPC 的发生率无差异（PHY/IS=12.3%，PHY=13.0%；p=0.88）。肺炎发生率也无差异（PHY/IS=4.6%，PHY=7.8%；p=0.21）、机械通气（PHY/IS=2.1%，PHY=1.0%；p=0.41）、家庭吸氧（PHY/IS=13.8%，PHY=14.6%；p=0.89）、住院时间（PHY/IS=4 天，PHY=4 天；p=0.34）或再入院率（PHY/IS=10.3%，PHY=9.9%；p=1.00）。