Shah Shraddha, Vaishali K, Prasad Shiva S, Babu Abraham Samuel
Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
Department of Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
Ann Med Surg (Lond). 2020 Dec 9;61:198-204. doi: 10.1016/j.amsu.2020.11.080. eCollection 2021 Jan.
Post-operative pulmonary complications are common after exploratory laparotomy. Good abdominal muscle functioning is essential for forced exhalation and effective coughing. However, the impact of a laparotomy on abdominal muscle activity remains uncertain. The study aimed to assess abdominal muscle activity during forced exhalation following elective laparotomy.
A was carried out on those undergoing (n = 30) their first elective laparotomy. Abdominal muscle activity, as percentage maximal voluntary contraction (%MVC), was assessed during forced exhalation using surface electromyography (EMG) for transverse abdominis (TrAb), external oblique (EO), and rectus abdominis (RA) pre-operatively and up to seven days post-operatively. Peak expiratory flow rate (PEFR) was assessed during the forced exhalation maneuver. Median %MVC was used to represent the trends and Z-scores to report the change from the baseline activity. Spearman's correlation was used for the correlation between %MVC and PEFR.
Pre-operatively, we observed the %MVC of TrAb (75.58%) to be the highest followed by RA (66.28%) and EO (62.12%). Post-operatively, all the muscles demonstrated increased activity wherein EO (84.33%) was most active on post-op day1, and for the rest of the days TrAb was the most active. However, as observed from Z-scores of all the three muscles the activity of EO was raised significantly from the baseline. No correlation was observed between %MVC and PEFR.
TrAb is the most active muscle that contributes to forced exhalation. Following an elective laparotomy, TrAb is no longer the most active muscle, rather it is the EO that primarily contributes to forced exhalation. This should be considered while providing post-operative respiratory care. However, more research is required in this area to better understand the role of expiratory muscle training for those undergoing elective laparotomies.
剖腹探查术后肺部并发症很常见。良好的腹肌功能对于用力呼气和有效咳嗽至关重要。然而，剖腹手术对腹肌活动的影响仍不确定。本研究旨在评估择期剖腹手术后用力呼气时的腹肌活动。
对30例接受首次择期剖腹手术的患者进行了研究。术前及术后最多7天，使用表面肌电图（EMG）评估腹横肌（TrAb）、腹外斜肌（EO）和腹直肌（RA）在用力呼气时的腹肌活动，以最大自主收缩百分比（%MVC）表示。在用力呼气动作中评估呼气峰值流速（PEFR）。使用中位数%MVC来表示趋势，使用Z分数来报告与基线活动的变化。使用Spearman相关性分析%MVC与PEFR之间的相关性。
术前，我们观察到TrAb的%MVC最高（75.58%），其次是RA（66.28%）和EO（62.12%）。术后，所有肌肉的活动均增加，其中EO在术后第1天最活跃，在其余时间TrAb最活跃。然而，从所有三块肌肉的Z分数来看，EO的活动较基线显著升高。未观察到%MVC与PEFR之间的相关性。
TrAb是对用力呼气起作用的最活跃肌肉。择期剖腹手术后，TrAb不再是最活跃的肌肉，而是EO主要对用力呼气起作用。在提供术后呼吸护理时应考虑到这一点。然而，该领域需要更多研究以更好地了解呼气肌训练对接受择期剖腹手术患者的作用。
