Breslin E H
Heart Lung. 1981 May-Jun;10(3):511-9.
Pulmonary complications are the leading cause of morbidity and death during the postoperative period in patients who have undergone upper abdominal surgery. Significant pulmonary mechanical alterations, such as reductions in VC, TV, and FRC and an increase in CV, are noted postoperatively in this patient population. Preexisting patient conditions, postoperative treatments, and certain respiratory maneuvers may increase the patient's risk in the development of postoperative pulmonary complications. Current research unanimously advocates sustained maximal inspiration, the normal physiologic sigh maneuver, as the best method of prevention and treatment of this problem. Commonly utilized maneuvers, such as blowing into a rubber glove or bag, blow bottles, and the like, should be avoided in all situations. A guide for preoperative and postoperative pulmonary assessment and care based on current research is included. After consideration of the data in addition to personal clinical experience, I conclude that to prevent pulmonary complications in patients after upper abdominal surgery, as well as in all hospitalized patients, sustained maximal inspiration, preferably with an incentive spirometer, and conscientious nurse supervision and coaching is the method of choice.
肺部并发症是上腹部手术后患者术后发病和死亡的主要原因。在这类患者群体中，术后可观察到显著的肺力学改变，如肺活量（VC）、潮气量（TV）和功能残气量（FRC）降低，而闭合气量（CV）增加。患者的基础病情、术后治疗以及某些呼吸动作可能会增加患者发生术后肺部并发症的风险。目前的研究一致主张持续最大吸气，即正常的生理性叹气动作，作为预防和治疗该问题的最佳方法。在任何情况下都应避免使用诸如吹橡胶手套或袋子、吹瓶等常用动作。本文包含了基于当前研究的术前和术后肺部评估及护理指南。综合考虑这些数据以及个人临床经验后，我得出结论：为预防上腹部手术后患者以及所有住院患者的肺部并发症，持续最大吸气，最好使用激励肺活量计，并由护士认真监督和指导，是首选方法。
