MD, PhD. Associate Professor, Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia; and Assistant Professor, Department of Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
MD, PhD. Assistant Professor, Department of Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
Sao Paulo Med J. 2021 Nov 15;139(6):556-563. doi: 10.1590/1516-3180.2021.0048.0904221. eCollection 2021.
Hypoxemia and pulmonary complications are common after upper abdominal surgery (UAS).
To examine whether inclusion of autogenic drainage (AD) in chest physiotherapy after UAS confers additional benefits in improving blood gases and reducing postoperative pulmonary complications (PPCs).
Randomized controlled study conducted at Kasr Al-Ainy teaching hospital, Egypt.
A randomized controlled trial was conducted on 48 subjects undergoing elective UAS with high risk of developing PPCs. The study group received AD plus routine chest physiotherapy (deep diaphragmatic breathing, localized breathing and splinted coughing) and the control group received routine chest physiotherapy only. The outcomes included arterial blood gases measured at the first and seventh postoperative days, incidence of PPCs within the first seven days and length of hospital stay.
Baseline characteristics were similar between groups. In the AD group, SaO2, PaO2, PaCO2 and HCO3 significantly improved (P < 0.05) while in the physiotherapy group, only SaO2 and PaO2 significantly improved (P < 0.05). Nonetheless, significant differences in post-treatment SaO2 and PaO2 between the groups were observed. The overall incidence of PPCs was 16.66% (12.5% in the AD group and 20.8% in the physiotherapy group) (absolute risk reduction -8.3%; 95% confidence interval, CI, -13.5 to 29.6%), with no significant difference between the groups. The AD group had a significantly shorter hospital stay (P = 0.0001).
Adding AD to routine chest physiotherapy after UAS provided a favorable blood gas outcome and reduced the length of hospital stay. It tended to reduce the incidence of PPCs.
ClinicalTrials.gov: NCT04446520.
上腹部手术后（UAS）常发生低氧血症和肺部并发症。
研究 UAS 后胸部物理治疗中包含自主引流（AD）是否能通过改善血气和减少术后肺部并发症（PPC）来带来额外益处。
在埃及的 Kasr Al-Ainy 教学医院进行的随机对照研究。
对 48 例有发生 PPC 高风险的择期 UAS 患者进行了一项随机对照试验。研究组接受 AD 加常规胸部物理治疗（深呼吸、局部呼吸和固定性咳嗽），对照组仅接受常规胸部物理治疗。结果包括术后第 1 天和第 7 天的动脉血气测量值、术后第 1 天至第 7 天内 PPC 的发生率和住院时间。
两组的基线特征相似。在 AD 组，SaO2、PaO2、PaCO2 和 HCO3 显著改善（P < 0.05），而在物理治疗组，只有 SaO2 和 PaO2 显著改善（P < 0.05）。然而，两组间治疗后 SaO2 和 PaO2 的差异具有统计学意义。PPC 的总发生率为 16.66%（AD 组 12.5%，物理治疗组 20.8%）（绝对风险降低 8.3%；95%置信区间，CI，-13.5 至 29.6%），两组间无显著差异。AD 组的住院时间明显缩短（P = 0.0001）。
在上腹部手术后常规胸部物理治疗中加入 AD 可改善血气结果并缩短住院时间。它可能降低 PPC 的发生率。
ClinicalTrials.gov：NCT04446520。
