Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Cardiothoracic Division, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Heart Lung Circ. 2020 Aug;29(8):1180-1186. doi: 10.1016/j.hlc.2019.09.009. Epub 2019 Oct 24.
Although the use of incentive spirometry with a deep breathing exercise (DBE) is widely used in clinical practice in patients who have undergone coronary artery bypass graft (CABG) surgery, the effect of this combination therapy has not been conclusively elucidated. The aim of this study was to investigate the effect of postoperative combined incentive spirometry and DBE versus DBE alone on inspiratory muscle strength following CABG.
This randomised clinical trial was conducted in patients scheduled to undergo CABG surgery at Siriraj Hospital, Bangkok Thailand. The study group received incentive spirometry and DBE, and the control group received DBE only. Maximal inspiratory pressure (MIP) before surgery and at day 4 after surgery was assessed by a respiratory pressure meter. Secondary outcomes, including postoperative pulmonary complication and duration of postoperative hospitalisation, were obtained from the medical records.
Ninety (90) patients were included, with 47 and 43 patients assigned to the study and control groups, respectively. In both groups, there was a significant reduction in MIP from preoperative baseline to postoperative day 4; however, the MIP in the incentive spirometry group had a significantly smaller reduction in MIP compared with the control group (33.0±23.2% vs 47.2±20.1%, respectively; p=0.006, 95% confidence interval, 3.9-23.3). There was no difference between groups regarding secondary outcomes.
Patients in the study group had significantly better recovery of inspiratory muscle strength on day 4 post-CABG than patients in the control group. There was no significant difference between groups for either postoperative pulmonary complications or length of hospital stay.
虽然在接受冠状动脉旁路移植术（CABG）的患者中广泛使用激励式呼吸训练（DBE）联合深呼吸运动，但这种联合治疗的效果尚未得到明确证实。本研究旨在探讨 CABG 术后联合激励式呼吸训练和 DBE 与单独 DBE 对吸气肌力量的影响。
这是一项在泰国曼谷 Siriraj 医院接受 CABG 手术的患者中进行的随机临床试验。研究组接受激励式呼吸训练和 DBE，对照组仅接受 DBE。使用呼吸压力计评估术前和术后第 4 天的最大吸气压力（MIP）。从病历中获得次要结局，包括术后肺部并发症和术后住院时间。
共纳入 90 例患者，其中研究组和对照组分别有 47 例和 43 例。两组患者的 MIP 均从术前基线水平显著下降至术后第 4 天，但激励式呼吸训练组的 MIP 下降幅度明显小于对照组（分别为 33.0±23.2%和 47.2±20.1%；p=0.006，95%置信区间，3.9-23.3）。两组患者的次要结局均无差异。
与对照组相比，研究组患者在 CABG 术后第 4 天的吸气肌力量恢复明显更好。两组患者在术后肺部并发症发生率或住院时间方面均无显著差异。
