|
| 呼吸训练器辅助预康复对肥胖患者腹腔镜下胆囊切除术后早期恢复的影响 |
| Effect of pre-rehabilitation assisted by respirator on early postoperative recovery of obese patients after laparoscopic cholecystectomy |
| |
| DOI：10.12089/jca.2022.09.002 |
| 中文关键词: 呼吸训练器 预康复 肥胖 肺部超声 早期恢复 |
| 英文关键词: Respiratory training device Pre-rehabilitation Obesity Lung ultrasound Early postoperative recovery |
| 基金项目: |
|
| 摘要点击次数: 1234 |
| 全文下载次数: 374 |
| 中文摘要: |
目的 探讨呼吸训练器辅助预康复对肥胖患者腹腔镜下胆囊切除术后早期恢复的影响。
方法 选择2019年6—12月全麻下行腹腔镜下胆囊切除手术的肥胖患者90例，男42例，女48例，年龄25~55岁，BMI 28～35 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为三组：对照组（C组）、预康复组（P组）和呼吸训练器辅助预康复组（M组），每组30例。C组仅采用传统术前宣教，P组术前两周采用预康复方案，M组术前两周采用呼吸训练器辅助预康复方案。于预康复前1 d（T0）、拔管后6 h（T1）、拔管后7 d（T3）测定用力肺活量（FVC）、第1秒用力呼气量（FEV1）和肺超声评分（LUS）。于T0、拔管后3 d（T2）、T3行6 min步行测试记录6 min步行距离（6MWD）。记录术后24 h内PCIA有效按压次数、PCIA总按压次数、补救镇痛例数。记录术后自主呼吸恢复时间、拔管时间、PACU停留时间、术后首次下床活动时间及术后住院时间。记录术后7 d内低氧血症（SpO2≤92%）、肺不张、肺部感染等肺部并发症（PPCs）的发生情况。
结果 与T0时比较，T1时C组、P组和M组FVC、FEV1明显降低（P<0.05），LUS评分明显升高（P<0.05）；T3时P组和M组FVC、FEV1明显升高（P<0.05），6MWD明显增加（P<0.05），C组、P组和M组LUS明显升高（P<0.05）。与C组比较，P组和M组T1、T3时FVC、FEV1明显升高，LUS评分明显降低（P<0.05），T3时6MWD明显增加（P<0.05），拔管时间、PACU停留时间明显缩短（P<0.05）；M组术后首次下床活动时间、术后住院时间明显缩短（P<0.05），术后低氧血症发生率明显降低（P<0.05）。与P组比较，M组T1、T3时FVC、FEV1明显升高（P<0.05），LUS评分明显降低（P<0.05），术后首次下床活动时间、术后住院时间明显缩短（P<0.05）。
结论 术前进行呼吸训练器辅助预康复措施能有效改善肥胖患者腹腔镜下胆囊切除肺部状况、提高术后运动耐力、降低低氧血症发生率，加速术后康复。 |
| 英文摘要: |
Objective To investigate the effect of pre-rehabilitation assisted by a breathing exerciser on early postoperative recovery of obese patients after laparoscopic cholecystectomy.
Methods Ninety obese patients undergoing elective laparoscopic cholecystectomy from June 2019 to December 2019, 42 males and 48 females, aged 25-55 years, BMI 28-35 kg/m2, ASA physical status Ⅰ or Ⅱ, were divided into three groups by random number table method: control group (group C), pre-rehabilitation group (group P), breathing trainer-assisted pre-rehabilitation group (group M), 30 patients in each group. Group C only received traditional preoperative education, group P implemented pre-rehabilitation strategies two weeks before operation, and group M implemented breathing trainer-assisted pre-rehabilitation strategy two weeks before operation. Forced vital capacity (FVC), forced expirtory volume in the first second (FEV1), and lung ultrasound score (LUS) were recorded 1 day before pre-rehabilitation exercise (T0), 6 hours after extubation (T1), and 7 days after extubation (T3). The 6-minute walk test (6MWT) was conducted and the 6-minute walk distance (6MWD) was recorded at T0, 3 days after anesthesia extubation (T2), and T3. Total number of analgesic pump compressions, the number of effective analgesic pump compressions, and the number of rescue analgesia were also recorded within 24 hours after operation. Respiration recovery time after surgery, extubation time, PACU stay time, the time of first postoperative ambulation, and postoperative hospital stay were recorded. The occurrence of postoperative pulmonary complications (PPCs) such as hypoxemia (SpO2≤ 92%), atelectasis, and pulmonary infection were recorded within 7 days after operation.
Results Compared with T0, FVC and FEV1 were significantly decreased, while LUS were significantly increased at T1 and T3 in groups C, P and M (P < 0.05), FVC, FEV1, and 6MWD were significantly increased at T3 in groups P and M (P < 0.05), and LUS were significantly increased at T3 in groups C, P and M (P < 0.05). Compared with group C, FVC and FEV1 were significantly increased, while LUS were significantly decreased at T1 and T3 in groups P and M (P < 0.05), 6MWD was significantly increased at T3 in groups P and M (P < 0.05), extubation time and PACU stay time were significantly shortened in groups P and M (P < 0.05), the time of first postoperative ambulation and postoperative hospital stay were significantly shortened in group M (P < 0.05), the incidence of postoperative hypoxemia were significantly lower in group M (P < 0.05). Compared with group P, FVC and FEV1 were significantly increased, while LUS were significantly decreased at T1 and T3 in group M (P < 0.05), the time of first postoperative ambulation and postoperative hospital stay were significantly shortened in group M (P < 0.05).
Conclusion Preoperative respiratory training device-assisted pre-rehabilitation measures can effectively improve the pulmonary condition in obese patients after laparoscopic cholecystectomy, enhance their exercise endurance level, reduce the incidence of hypoxemia, thus facilitating recovery after surgery. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
