高频胸壁振荡在腹壁切口疝手术后治疗中的应用价值

Application value of high frequency chest wall oscillation after operation of abdominal incisional hernia

目的：探讨高频胸壁振荡在腹壁切口疝手术后治疗中的应用价值。方法：采用前瞻性研究方法。选取2014年1月至2015年9月复旦大学附属华东医院收治的50例行腹壁切口疝手术后患者，采用随机、双盲对照，通过随机数字表法将入组患者分为试验组（术后行高频胸壁振荡治疗）和对照组（术后行传统人工胸部物理治疗）。观察指标：（1）不良事件。（2）疼痛程度：采用视觉模拟评分（VAS）评估患者术后第1～5天的疼痛程度。（3）呼吸功能：患者术后第1、3、5天的动脉血氧饱和度、氧合指数、动脉血氧分压、动脉血二氧化碳分压。（4）随访情况。采用门诊和电话方式进行随访，了解患者恢复情况。随访时间截至2016年3月。正态分布的计量资料以±s表示，组间比较采用t检验；重复测量数据采用重复测量方差分析。计数资料比较采用χ2检验。结果：筛选出符合研究条件的患者50例，每组各25例。（1）不良事件：试验组和对照组患者均顺利完成试验。治疗过程中，无低氧血症、血流动力学不稳定、心律失常、支气管痉挛、呕吐、伤口裂开、导管脱落等不良事件发生。（2）疼痛程度：试验组患者术后行胸部治疗前至术后第5天VAS为（1.7±1.0）分～（1.5±1.1）分，对照组患者为（1.4±0.8）分～（1.8±0.6）分。两组疼痛程度变化趋势比较，差异有统计学意义（F=0.02，P〈0.05）。术后第2、3、4天两组患者疼痛程度比较，差异均有统计学意义（t=0.01，0.01，0.01，P〈0.05）。（3）呼吸功能：试验组患者术后行胸部治疗前至术后第5天动脉血氧饱和度为97.9%±2.2%～99.2%±0.9%，对照组患者为98.2%±2.3%～98.8%±2.0%；氧合指数试验组患者为（300±47）mmHg（1 mmHg=0.133 kPa）～（337±59）mmHg，对照组患者为（311±29）mmHg～（347±61）mmHg；动脉血氧分压试验组患者为（103±49）mmHg～（104±17）mmHg，对照组患者为（99±15）mmHg～（103±14）mmHg。两组患者动脉血氧饱和度、氧合指数、动脉血氧分压变化趋势比较，差异均无统计学意义（F=0.83，0.50，0.59，P〉0.05）。（4）随访情况：43例患者出院后获得随访。随访时间为1～6个月，中位随访时间为5个月。随访期间，患者无胸闷、气促等不适发生，伤口愈合良好。结论与常规胸部物理治疗比较，高频胸壁振荡可短期减轻腹壁切口疝手术后患者疼痛，提高患者耐受性。

Objective：To investigate the application value of high frequency chest wall oscillation （HFCWO） after operation of abdominal incisional hernia. Methods：A prospectively randomized doubleblind study was adopted. Fifty patients who underwent operation of abdominal incisional hernia at the Huadong Hospital Affiliated to Fudan University between January 2014 and September 2015 were allocated into the HFCWO group （undergoing postoperative HFCWO） and control group [undergoing postoperative conventional chest physiotherapy （CPT ）] using random number table. Observation indicators included： （1） adverse events, （2） pain perception index： postoperative pain intensity from 1 day to 5 days was assessed by visual analogue scale （VAS）, （3） respiratory function： arterial oxygen saturation （SaO2）, oxygenation index （OI）, arterial partial pressure of oxygen （PaO2） and arterial partial pressure of carbon dioxide （PaCO2） at postoperative day 1, 3 and 5, （4） followup. The followup using outpatient examination and telephone interview was performed to detect the recovery of patients up to March 2016. Measurement data with normal distribution were represented as ±s. The comparisons between groups were evaluated with the t test. The repeated measurement data were done using the repeated measures ANOVA and the count data were analyzed using the chisquare test. Results：Fifty patients were screened for eligibility and were allocated into the 2 groups, 25 in each group. （1） Adverse events： all the patients in the 2 groups underwent successfully treatment, without the occurrence of hypoxemia, hemodynamic instability, arrhythmia, bronchospasm, vomiting, wound dehiscence, shedding catheter and so on. （2） Pain perception index： VAS from before chest treatment to postoperative day 5 was from 1.7±1.0 to 1.5±1.1 in the HFCWO group and from 1.4±0.8 to 1.8±0.6 in the control group, with a statistically significant difference in the change trend of pain intensity between the 2 groups （F=0.02, P〈0. 05） and in the pain intensity at postoperative day 2, 3 and 4 between the 2 groups （t= 0.01, 0.01, 0.01, P〈0. 05）. （3） Respiratory function： arterial SaO2, OI and arterial PaO2 from before chest treatment to postoperative day 5 was from 97.9%±2.2% to 99.2%±0.9%, from （300±47）mmHg （1 mmHg=0.133 kPa） to （337±59）mmHg, from （103±49）mmHg to （104±17）mmHg in the HFCWO group and from 98.2%±2.3% to 98.8%±2.0%, from （311±29）mmHg to （347±61）mmHg, from （99±15）mmHg to （103±14）mmHg in the control group, with statistically significant differences in the change trends of above indicators between the 2 groups （F=0.83, 0.50, 0.59, P〉0. 05）. （4） Followup： 43 patients were followed up after discharge from hospital for 1-6 months, with a median time of 5 months. During the followup, patients were not complicated with chest tightness and shortness of breath, with good wound healing. Conclusion：Compared with conventional chest physiotherapy, HFCWO could improve tolerability of patients and reduce the pain after operation of abdominal incisional hernia.