综合胸部物理治疗在体外循环手术患者中的应用

Application of comprehensive chest physical therapy in patients with extracorporeal circulation operation

目的 探讨综合胸部物理治疗在体外循环手术患者中的应用效果.方法 选取2016年6—9月南京医科大学附属南京医院心胸外科90例拟全麻下行体外循环心脏手术的患者为研究对象,随机分为A、B、C三组,每组30例.A组患者给予常规护理,B、C组在常规护理的基础上,分别于术后、入院当天开始实施综合胸部物理治疗.比较三组患者拔除经口气管插管后深吸气量、咳痰疼痛评分、舒适度评分以及肺部感染发生率、肺不张发生率、总住院时间、术后住院时间.结果 重复测量方差分析显示,干预前后不同时间患者拔除经口气管插管后深吸气量、咳痰疼痛评分、拔管后舒适度评分,差异均有统计学意义（F时间分别为77.319、70.463、21.434;P〈0.05）;A、B、C三组患者拔除经口气管插管后深吸气量、痰疼痛评分、拔管后舒适度评分,差异均有统计学意义（F组间分别为29.194、8.272、27.177;P〈0.05）;深吸气量测量前后与干预之间存在交互作用（F交互=5.889,P〈0.05）.三组患者深吸气量较术前均先下降后逐渐回升,但回升速度C组〉B组〉A组;C组深吸气量值每日均高于A、B组,差异有统计学意义（P〈0.05）,B组深吸气量于术后第3天开始高于A组,差异有统计学意义（P〈0.05）;三组患者咳痰疼痛评分均先升高后下降,趋势基本相同;三组患者拔管后第2天开始,C组咳痰疼痛评分低于A组,第3天开始,B组疼痛评分低于A组,差异有统计学意义（P〈0.05）;三组患者拔管后舒适度评分均先升高后下降,趋势基本相同,B、C组患者不适程度每日均低于A组（P〈0.05）.三组患者术后住院时间比较,差异有统计学意义（P〈0.05）,C组术后住院时间短于A组,差异有统计学意义（P〈0.05）.结论 综合胸部物理治疗可以加快体外循环心脏手术患者术后康复速度、改善患者舒适度、减少术后住院时间.

Objective To evaluate the effects of comprehensive chest physical therapy in patients with extracorporeal circulation operation. Methods A total of 90 patients with extracorporeal circulation operation under general anesthesia were recruited in Department of Thoracic Surgery, The Affiliated Nanjing Hospital of Nanjing Medical University from June to September 2016 and all patients were randomly divided into A, B, and C three groups, 30 cases in each. Patients in group A received conventional nursing measures, while group B and C received extro comprehensive chest physical therapy after operation and on the admission day respectively. Deep inspiratory capacity after removing orotracheal intubation, coughing pain score, comfort score, incidence of pulmonary infection, atelectasis, length of hospital stay, postoperative hospital stay were investigated. Results Repeated measures analysis of variance showed that deep inspiratory capacity after removing the orotracheal intubation, coughing pain score, comfort score were different before and after the intervention （F time=77.319, 70.463, 21.434; P〈0.05）; deep inspiratory capacity after removing the orotracheal intubation, coughing pain score, comfort score of group A, B, and C were different （Fgroup= 29.194, 8.272, 27.177; P 〈 0.05）; for deep inspiratory capacity, there was interaction between time and group （Ftime× group= 5.889, P〈0.05）. Deep inspiratory capacity of patients of three groups all fell before gradually recovered compared with those of before operation, with recovery rate group C〉group B 〉group A; daily deep inspiration capacity of group C were higher than those of group A and B（P〈 0.05）; deep inspiratory capacity of group B was higher than that of group A on postoperative 3rd day （P〈0.05）. Coughing pain score of group C was lower than that of group A on 2nd day, and on 3rd day, coughing pain score of group B was lower than group A （P〈0.05）.Comfort score of 3 group increased at first and then decreased. Comfort score of group B and C were not different （P〉0.05）, but better than that of group A（P〈0.05）. The postoperative hospital stay among the three groups was different （P〈0.05）. Group C had a shorter hospital stay than that of group A （P〈0.05）. Conclusions Comprehensive chest physical therapy could speed up the recovery postoperatively, improve patient comfort, reduce postoperative hospital stay for patients with extracorporeal circulation surgery.