三种呼吸技术对瓣膜置换术后患者肺功能、功能能力及日常生活功能任务的对比效果——一项前瞻性随机临床试验
Contrasting effects of three breathing techniques on pulmonary function, functional capacity and daily life functional tasks in patients following valve replacement surgery- A pilot randomized clinical trial.
作者信息
Alaparthi Gopala Krishna, Amin Revati, Gatty Aishwarya, Raghavan Harish, Bairapareddy Kalyana Chakravarthy, Vaishali K, Borghi-Silva Audrey, Hegazy Fatma A
机构信息
Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
出版信息
Heliyon. 2021 Jul 22;7(7):e07643. doi: 10.1016/j.heliyon.2021.e07643. eCollection 2021 Jul.
BACKGROUND
Valve replacement surgeries affect the physiological mechanisms of patients leading to various postoperative pulmonary complications. Lung expansion therapy consisting of numerous techniques is routinely used for the prevention and treatment of these complications.
OBJECTIVES
Our study aimed to compare the effects of diaphragmatic breathing (DB), flow (FS) and volume-oriented incentive spirometer (VS) in patients following valve replacement surgery.
METHODS
29 patients posted valve replacement surgeries were randomly assigned to VS, FS and DB groups. Patients underwent preoperative training and seven-day rehabilitation post-surgery. Pulmonary function tests were performed before surgery and for seven days afterward. On the seventh postoperative day, patients performed a six-minute walk test and completed a functional difficulties questionnaire (FDQ).
RESULTS
Pulmonary function test values reduced in all three groups postoperatively when compared to the preoperative values but improved by the seventh postoperative day (p < 0.05). On comparing the seventh postoperative day values to the preoperative values, the VS group had no significant difference (p = 1.00) (Forced Vital Capacity- % change: DB-37.76, VS-1.59, FS-27.98), indicating that the value had nearly returned to the baseline. As compared to the DB and FS groups, FVC showed a greater improvement in the VS group (p = 0.01 and p = 0.06 respectively). No significant differences were observed between groups for distance walked (p > 0.05), however, FDQ scores demonstrated positive changes in favor of VS when contrasted with FS or DB (p < 0.05).
CONCLUSION
Diaphragmatic breathing, flow or volume-oriented spirometer could improve pulmonary function in the postoperative period. The volume-oriented spirometer, however, was found to be the most beneficial among the three techniques in improving patients' pulmonary function and daily life functional tasks. Further research is warranted to confirm these findings.
背景
瓣膜置换手术会影响患者的生理机制，导致各种术后肺部并发症。由多种技术组成的肺扩张治疗通常用于预防和治疗这些并发症。
目的
我们的研究旨在比较膈肌呼吸（DB）、流量（FS）和容量导向激励肺活量计（VS）对瓣膜置换手术后患者的影响。
方法
29例接受瓣膜置换手术的患者被随机分配到VS、FS和DB组。患者在术前接受训练，并在术后进行为期七天的康复治疗。在手术前和术后七天进行肺功能测试。术后第七天，患者进行六分钟步行测试并完成功能困难问卷（FDQ）。
结果
与术前值相比，所有三组术后肺功能测试值均降低，但在术后第七天有所改善（p < 0.05）。将术后第七天的值与术前值进行比较时，VS组无显著差异（p = 1.00）（用力肺活量-%变化：DB-37.76，VS-1.59，FS-27.98），表明该值几乎已恢复到基线。与DB组和FS组相比，VS组的用力肺活量改善更大（分别为p = 0.01和p = 0.06）。各组之间步行距离无显著差异（p > 0.05），然而，与FS或DB相比，FDQ评分显示有利于VS的积极变化（p < 0.05）。
结论
膈肌呼吸、流量或容量导向肺活量计可改善术后肺功能。然而，在改善患者肺功能和日常生活功能任务方面，容量导向肺活量计被发现是三种技术中最有益的。需要进一步研究来证实这些发现。
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