Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil (Ms Cargnin and Dr Dal Lago); Programa de Pós-graduação em Ciências da Reabilitação (UFCSPA), Porto Alegre, Brazil (Drs Karsten and Dal Lago); Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil (Dr Karsten); Programa de Pós-graduação em Fisioterapia (UDESC), Florianópolis, Brazil (Dr Karsten); Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil (Dr Guaragna); and Departamento de Fisioterapia (UFCSPA), Porto Alegre, Brazil (Dr Dal Lago).
J Cardiopulm Rehabil Prev. 2019 Sep;39(5):E1-E7. doi: 10.1097/HCR.0000000000000409.
The aim of this study was to analyze the effects of inspiratory muscle training (IMT) as a therapeutic strategy after heart valve replacement surgery (HVRS).
A double-blind, randomized, clinical trial that included patients undergoing elective HVRS, without post-operative complications, were allocated to 2 groups: IMT group (IMT-G) and IMT placebo group (IMT-PG). The IMT started 3 d after surgery and was performed twice daily for 4 wk. Lung function, maximum inspiratory pressure (MIP) as a measure of inspiratory muscle strength, functional capacity, and quality of life were assessed pre-operatively and at the end of training.
The IMT-G recovered pre-operative MIP and lung function values after 4 wk of training. This group also increased the distance walked during the 6-min walk test (6MWD). In the IMT-PG, the values of MIP were below those found pre-operatively, with impairment of lung function and lower 6MWD in the final evaluation. At the end of IMT, MIP was correlated with the 6MWD and with the spirometry variables.
IMT performed for 4 wk after HVRS was effective in restoring the values of inspiratory muscle strength and lung function to the pre-operative level and increasing the functional capacity assessed by the 6MWD. Furthermore, an association between lung function and functional capacity was observed, demonstrating the clinical relevance of the use of IMT in the rehabilitation process of these patients.
本研究旨在分析吸气肌训练(IMT)作为心脏瓣膜置换术后(HVRS)治疗策略的效果。
这是一项双盲、随机、临床试验,纳入了接受择期 HVRS 且无术后并发症的患者,将其分为 2 组:吸气肌训练组(IMT-G)和吸气肌训练安慰剂组(IMT-PG)。IMT 于术后 3 天开始,每天进行 2 次,持续 4 周。在术前和训练结束时评估肺功能、最大吸气压力(MIP)作为吸气肌力量的衡量指标、功能能力和生活质量。
IMT-G 在 4 周的训练后恢复了术前的 MIP 和肺功能值。该组还增加了 6 分钟步行测试(6MWD)中的步行距离。在 IMT-PG 中,MIP 值低于术前值,肺功能受损,最终评估时 6MWD 较低。在 IMT 结束时,MIP 与 6MWD 和肺功能变量相关。
HVRS 后进行 4 周的 IMT 有效恢复了吸气肌力量和肺功能的术前水平,并增加了 6MWD 评估的功能能力。此外,观察到肺功能和功能能力之间存在关联,表明在这些患者的康复过程中使用 IMT 的临床相关性。