Larsen K R, Ingwersen U, Bertelsen M T, Kiil-Nielsen K, Laub M S, Bach K S, Hansen K H, Sandermann J
Thoraxkirurgisk afdeling R, fysioterapiafsnittet, Amtssygehuset i Gentofte.
Ugeskr Laeger. 1994 Sep 26;156(39):5689-92.
The object of the investigation was to compare the effect of three different physiotherapy masks on the incidence of postoperative complications after thoracic surgery. It was carried out as a prospective, consecutive, randomized comparison at a Department of Thoracic and Heart Surgery at a University Hospital. The therapy was performed by experienced and specially trained physiotherapists. One hundred and sixty patients were evaluated; 60 patients undergoing heart surgery, 59 patients having pulmonary resection, and 41 patients with exploratory thoracotomy. In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy. These were either continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), or inspiratory resistance--positive expiratory pressure (IR-PEP). Postoperative pulmonary complications were assessed by forced vital capacity (FVC), arterial oxygen tension (PaO2), and chest X-ray examination, all parameters were measured preoperatively and on the fourth and ninth postoperative day. The patients filled in a questionnaire concerning their opinions about their mask treatment. IR-PEP showed a lesser decrease in PaO2 on day nine. Otherwise there was an equal decrease in FVC and PaO2, and equal frequency of atelectasis in the three mask treatments. It is therefore concluded that any of the three therapies: continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), and inspiratory resistance--positive expiratory pressure (IR-PEP) may be used as supplement to standard chest physiotherapy.
该研究的目的是比较三种不同物理治疗面罩对胸外科手术后并发症发生率的影响。研究在一所大学医院的胸心外科进行，采用前瞻性、连续性、随机对照比较。治疗由经验丰富且经过专门培训的物理治疗师进行。共评估了160例患者，其中60例行心脏手术，59例行肺切除术，41例行开胸探查术。在每个手术类别中，患者除接受常规胸部物理治疗外，还使用三种面罩系统之一进行治疗，分别为持续气道正压通气（CPAP）、呼气末正压（PEP）或吸气阻力 - 呼气末正压（IR - PEP）。术后肺部并发症通过用力肺活量（FVC）、动脉血氧分压（PaO2）和胸部X线检查进行评估，所有参数均在术前以及术后第4天和第9天进行测量。患者填写了一份关于他们对面罩治疗看法的问卷。结果显示，在术后第9天，IR - PEP组的PaO2下降幅度较小。除此之外，三种面罩治疗在FVC和PaO2的下降幅度以及肺不张的发生率方面相当。因此得出结论，持续气道正压通气（CPAP）、呼气末正压（PEP）和吸气阻力 - 呼气末正压（IR - PEP）这三种治疗方法中的任何一种都可作为标准胸部物理治疗的补充。
