术前五天强化吸气肌训练对心脏手术患者术后并发症和结局的影响：一项随机对照试验。
The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: a randomized controlled trial.
机构信息
1 Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.
2 Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China.
出版信息
Clin Rehabil. 2019 May;33(5):913-922. doi: 10.1177/0269215519828212. Epub 2019 Feb 6.
OBJECTIVE
To determine the prophylactic efficacy of short-term intensive preoperative inspiratory muscle training on the incidence of postoperative pulmonary complications in patients scheduled for cardiac surgery.
DESIGN
Single-blind, randomized controlled pilot study.
SETTING
TEDA International Cardiovascular Hospital, China.
SUBJECTS
In total, 197 subjects aged ⩾50 years scheduled for cardiac surgery were selected.
INTERVENTION
The intervention group ( n = 98) received five days of preoperative inspiratory muscle training on top of the usual care received by the patients in the control group ( n = 99).
MAIN MEASURES
The primary outcome variable was the occurrence of postoperative pulmonary complications. The secondary outcome variables were inspiratory muscle strength, lung function and length of hospitalization.
RESULTS
After cardiac surgery, a total of 10 (10.2%) of the 98 patients in the intervention group and 27 (27.3%) of 99 patients in the control group had postoperative pulmonary complications (risk ratio, 0.23; 95% confidence interval (CI), 0.09-0.58, P = 0.002). The study revealed that, compared with the control group, the intervention group had a significant increase in inspiratory muscle strength (by 10.48 cm HO, P < 0.001), forced expiratory volume in the first second of expiration (FEV1) %predicted (by 3.75%, P = 0.030), forced vital capacity (FVC) %predicted (by 4.15%, P = 0.008) and maximal voluntary ventilation (MVV) %predicted (by 6.44%, P = 0.034). Length of hospital stay was 7.51 (2.83) days in the intervention group and 9.38 (3.10) days in the control group ( P = 0.039).
CONCLUSION
A five-day intensive pattern of preoperative inspiratory muscle training reduced the incidence of postoperative pulmonary complications and duration of postoperative hospitalization in patients undergoing cardiac surgery.
目的
确定短期强化术前呼吸肌训练对拟行心脏手术患者术后肺部并发症发生率的预防效果。
设计
单盲、随机对照初步研究。
地点
中国泰达国际心血管病医院。
对象
共纳入 197 名年龄 ⩾50 岁、拟行心脏手术的患者。
干预
干预组（n=98）在对照组（n=99）常规治疗的基础上，接受 5 天的术前呼吸肌训练。
主要观察指标
主要结局变量是术后肺部并发症的发生情况。次要结局变量是吸气肌力量、肺功能和住院时间。
结果
心脏手术后，干预组 98 例患者中共有 10 例（10.2%）和对照组 99 例患者中共有 27 例（27.3%）发生术后肺部并发症（风险比，0.23；95%置信区间，0.09-0.58，P=0.002）。研究表明，与对照组相比，干预组吸气肌力量显著增加（增加 10.48cmH2O，P<0.001），第一秒用力呼气量占预计值百分比（FEV1%pred）（增加 3.75%，P=0.030）、用力肺活量（FVC）%pred（增加 4.15%，P=0.008）和最大自主通气量（MVV）%pred（增加 6.44%，P=0.034）。干预组的住院时间为 7.51（2.83）天，对照组为 9.38（3.10）天（P=0.039）。
结论
5 天强化术前呼吸肌训练可降低拟行心脏手术患者术后肺部并发症的发生率和术后住院时间。
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