呼吸功能锻炼器在老年体外循环心脏手术患者围术期中的应用

Application of respiratory exercise apparatus in the perioperative period of elderly patients undergoing cardiopulmonary bypass

目的 本研究拟探讨呼吸功能锻炼器在老年患者心肺转流(CPB)心脏手术围术期的应用价值。方法 纳入2017年1月至2019年12月在本科行CPB手术的60岁以上老年患者进行回顾性分析。在围术期使用了呼吸功能锻炼器的患者被纳入观察组,而对照组患者均在围术期进行常规呼吸训练。结果 共纳入115例患者,其中对照组63例、观察组52例。观察组患者在麻醉诱导后、术后2 h、术后4 h时的氧合指数显著高于对照组(P<0.05)。术后不良事件包括急性肾损伤、呼吸机相关性肺炎、二次插管、主动脉内球囊反搏置入、室性心律失常在两组间的发生率无显著性差异。围术期借助呼吸功能锻炼器进行呼吸训练,能够显著降低患者的机械通气时间(P<0.05),但是在术后左室射血分数、ICU停留时间及总住院日则未有显著改善。结论 呼吸功能锻炼器在老年CPB手术围术期的使用安全有效,其能够改善氧合、提高肺功能储备,并有利于术后快速康复,值得在临床中广泛推广。

Objective To explore the application value of respiratory exercise apparatus in the perioperative period of elderly patients undergoing cardiopulmonary bypass(CPB). Methods The elderly patients over 60 years old who underwent CPB in our department from January 2017 to December 2019 were selected and analyzed retrospectively. Patients who used respiratory exercise apparatus during the perioperative period were enrolled in the observation group, while patients in the control group received routine breathing training method. Results A total of 144 patients(63 patients in control group and 52 patients in observation group) were included. The oxygenation index in the observation group was significantly higher than that in the control group after anesthesia induction, 2 h and 4 h after the operation(P<0.05). There was no significant difference in the incidence of postoperative adverse events including acute kidney injury, ventilator-associated pneumonia, re-intubation, intra-aortic balloon pump implantation, and ventricular arrhythmias between the two groups. Perioperative respiratory training with the aid of respiratory exercise apparatus could significantly reduce the mechanical ventilation time of patients(P<0.05), but there was no significant improvement in postoperative left ventricular ejection fraction, ICU stay time and total hospital stay. Conclusion Respiratory exercise apparatus is safe and effective in the perioperative period of elderly CPB surgery. It can improve oxygenation, strengthen lung function reserve, and facilitate rapid postoperative recovery, which is worthy of wide promotion in clinical practice.