Department of Cardiac Surgery, Xingtai People's Hospital, Xingtai, Hebei, China.
Medicine (Baltimore). 2022 Dec 30;101(52):e32443. doi: 10.1097/MD.0000000000032443.
Atelectasis is the most occurring postoperative complication after cardiac surgeries. Postoperative respiratory exercises and incentive spirometry led to decrease in postoperative complications, especially atelectasis and hospital stay. The objectives of the study were to evaluate postoperative complications and length of hospital stay of patients who received pre and postoperative nurse-guided incentive spirometry against those of patients who received pre and postoperative breathing exercises by the physiotherapist in patients who underwent cardiac surgery. Data of patients who received 2 days preoperative and 2 days postoperative nurse-guided incentive spirometry with a spirometer (PPN cohort, n = 102) or received 2 days preoperative and 2 days postoperative breathing exercises by physiotherapist without spirometer (PPP cohort, n = 105), or 2 days postoperative physiotherapist-guided breathing exercises only without spirometer (PPB cohort, n = 114) were collected and analyzed. The acute or chronic collapse of part or entire lung was defined as atelectasis. The length of stay in the hospital was from the day of admission to discharge. Patients of the PPN cohort had fewer numbers of incidences of atelectasis, dyspnea, and sweating >1 day after operations compared to those of the PPB and the PPP cohorts (P < .05 for all). The partial pressure of oxygen and oxygen saturation of arterial blood ≥6 hours after operations reported higher, the duration of ventilation was shorter, and numbers of re-intubation processes reported fewer for patients of the PPN cohort than those of the PPB and the PPP cohorts (P < .05 for all). The hospital length of the stay of patients in the PPN cohort was fewer than those of the PPB and the PPP (P < .0001 for both) cohorts. Pre and postoperative nurse-guided incentive spirometry with a spirometer following cardiac surgeries would have better postoperative pulmonary outcomes and fewer hospital stays than those of postoperative-only or pre and postoperative physiotherapist-guided breathing exercises (level of evidence: IV; technical efficacy stage: 5).
肺不张是心脏手术后最常见的术后并发症。术后呼吸锻炼和激励式肺活量计可减少术后并发症，特别是肺不张和住院时间。本研究的目的是评估接受术前和术后护士指导激励式肺活量计与接受术前和术后物理治疗师指导呼吸锻炼的患者术后并发症和住院时间，这些患者接受了心脏手术。收集并分析了接受 2 天术前和术后护士指导激励式肺活量计（使用肺活量计）（PPN 队列，n=102）或接受 2 天术前和术后物理治疗师指导无肺活量计的呼吸锻炼（PPP 队列，n=105）或仅在术后 2 天接受物理治疗师指导无肺活量计的呼吸锻炼（PPB 队列，n=114）的患者的数据。急性或慢性部分或全部肺塌陷定义为肺不张。住院时间从入院到出院。与 PPB 和 PPP 队列相比，PPN 队列的患者术后发生肺不张、呼吸困难和出汗超过 1 天的发生率较少（所有 P<0.05）。术后 6 小时动脉血氧分压和血氧饱和度报告较高，通气时间较短，PPN 队列的患者再插管次数较 PPB 和 PPP 队列报告较少（所有 P<0.05）。PPN 队列的患者住院时间短于 PPB 和 PPP 队列（两者均 P<0.0001）。与术后仅或术前和术后物理治疗师指导呼吸锻炼相比，心脏手术后进行术前和术后护士指导激励式肺活量计（使用肺活量计）可改善术后肺部结果，减少住院时间（证据水平：IV；技术功效阶段：5）。
