术前呼气阻力训练对体外循环冠状动脉旁路移植术患者肺气体交换功能的影响

Effects of preoperative positive-expiratory-pressure breathing exercises on perioperative lung gas exchange in patients undergoing CABG with cardiopulmonary bypass

目的探讨术前开展呼气阻力(PEP)训练对体外循环冠状动脉旁路移植术(CABG)患者围术期肺气体交换功能的影响。方法选取解放军总医院心血管外科2016年1月至2016年10月择期体外循环CABG患者110名为研究对象,随机分为试验组和对照组。试验组术前给予呼气阻力训练,对照组术前给予普通的深呼吸训练,观察两组患者入院时、术前1日及术后第1至第3日动脉血气分析变化。结果两组患者术前1日、术后第1至第3日的氧合指数(OI)与入院时基线相比,试验组术前1日明显增加,对照组术前1日无显著变化,但两组术后各时点均显著降低;试验组OI在术前1日及术后第2日、第3日明显高于对照组;两组患者不同时点OI存在交互作用。两组患者术前1日、术后第1至第3日的动脉血氧饱和度(Sa O2)与入院时基线相比,试验组术前1日及术后各时点均有增加,对照组术前1日及术后各时点均无显著差异;试验组术后第2日、第3日的Sa O2明显高于对照组;两组患者不同时点Sa O2存在交互作用(P <0.05)。两组患者动脉血二氧化碳分压(PaCO2)组内及组间均无显著差异。结论术前呼气阻力训练能有效促进CABG患者术后早期肺气体交换功能的恢复。

Objective To investigate the efficacy of preoperative positive-expiratory-pressure (PEP) breathing exercises on perioperative pulmonary function in patients undergoing coronary artery bypass graft (CABG).Methods Between January 2016 and August 2016,110 patients undergoing elective CABG surgery in our department were randomly assigned to test group or control group according to whether receiving PEP breathing or regular deep breathing exercises before surgery. Artery blood gas was analyzed at baseline,the day before surgery,as well as the first,second and third day after surgery.Results OI was higher in test group on the day before surgery,the second (POD2) and third (POD3) day after surgery compared with control group (P<0.05).SaO2 increased in test group on the day before surgery,POD1,POD2 and POD3 but remained the same at all time-points in control group.SaO2 in test group was higher than that in control group on POD2 and POD3.No difference in PaCO2 was found at all time-points between the two groups.Conclusion Preoperative PEP breathing exercises could promote lung gas exchange recovery at early stage in patients undergoing CABG.