Rocha Maura Rigoldi Simões da, Souza Stefane, Costa Carolina Moraes da, Merino Daniela Faleiros Bertelli, Montebelo Maria Imaculada de Lima, Rasera-Júnior Irineu, Pazzianotto-Forti Eli Maria
Universidade Metodista de Piracicaba.
Clínica Bariátrica de Piracicaba, Piracicaba, SP, Brazil.
Arq Bras Cir Dig. 2018;31(2):e1363. doi: 10.1590/0102-672020180001e1363. Epub 2018 Jul 2.
Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction.
To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty.
Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day.
There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them.
Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.
减肥手术可能因手术本身固有的因素引发术后肺部并发症，主要是由于膈肌功能障碍。
评估并比较两种正压水平及吸气负荷训练对肺功能、吸气肌力量和呼吸肌阻力的影响，以及胃成形术后肺不张的发生率。
临床随机双盲试验，纳入接受减肥手术的受试者，分为两组：正压组，在一小时内接受两个水平的正压通气及常规呼吸物理治疗；吸气负荷组，除常规呼吸物理治疗外，进行线性吸气压力负荷训练，每组15次重复，共6组，术后即刻进行两次，术后第一天每天进行三次。术前及术后第二天出院时进行肺活量测定以分析肺功能，测量鼻吸气压力以评估吸气肌力量，进行呼吸肌阻力递增试验以测定持续最大吸气压力。
组内及组间比较，术前和术后呼气储备量及潮气量无显著差异（p>0.05）。吸气负荷组组内评估时，鼻吸气压力及维持的最大吸气压力无显著差异（p>0.05），但与正压组相比有显著差异（p<0.05）。两组肺不张发生率均为5%，组间无显著差异（p>0.05）。
两组联合常规呼吸物理治疗，均保留了呼气储备量和潮气量，肺不张发生率低。吸气负荷组仍维持了吸气肌力量和呼吸肌阻力。
