术前呼气阻力训练对体外循环冠状动脉旁路移植术患者围术期肺功能的影响

Effects of preoperative positive expiratory pressure breathing exercises on perioperative pulmonary function in patients undergoing coronary artery bypass graft

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PEP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天及术后第6天肺功能指标。结果两组患者术后第6天肺活量占预测值的百分比(VC%)、潮气量占预测值的百分比(VT%)、用力肺活量占预测值的百分比(FVC%)、第1秒用力呼气容积占预测值的百分比(FEV1%)及呼气峰值流速占预测值的百分比(PEF%)较入院时均有显著降低{P<α’(0.017)};两组患者各项指标在入院时、术前1天及术后第6天各相同时点比较没有显著差异,但VT%及PEF%存在交互效应(P<0.05),试验组此两项指标在术前1天增幅明显,术后第6天的降幅较小。结论术前PEP训练有利于体外循环CABG患者围术期肺功能的恢复。

Objective To investigate the efficacy of preoperative positive-expiratory-pressure （PEP） breathing on perioperarive pulmonary function in patients undergoing coronary artery bypass graft （CABG）. Methods Between January 2016 and August 2016, 110 patients referred for elective CABG surgery at department of cardiovascular surgery, General Hospital of PLA were enrolled and randomly assigned to test group and control group which received PEP breathing and regular deep breathing exercises respectively before surgery. Pulmonary function test were performed at baseline, the day before surgery and the sixth postoperative day （POD6）. Results VC % ,VT% ,FVC%,FEVI% and PEF% were siguificantly reduced in both test and control groups（ P 〈0.017） on POD6 and were similar between the two groups. The change of VT% and PEF% was significant on preoperative day 1 and postoperative day 6, Interaction was seen in PEF% differently in different risk stratification. Conclusion Preoperative PEP breathing exercises could improve perioperative pulmonary function, especially in patients with high-risk of PPCs.