吸气肌训练对食管癌根治术后患者心肺功能及生活质量的影响  

Effects of inspiratory muscle training on postoperative cardiopulmonary function and quality of life after oesophagectomy

作　　者：魏利娟[1] 马亚飞[1] 伍军[1] 李利霞[1] 张三虎[1] 陈小莉[1] 

机构地区：[1]河南科技大学第一附属医院麻醉科,洛阳471000

出　　处：《中华物理医学与康复杂志》2015年第1期40-44,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的 观察术前和术后吸气肌训练对食管癌根治术后患者心肺功能及生活质量的影响.方法 共选取60例择期拟行食管癌根治术患者,采用随机数字表法将其分为对照组及观察组,每组30例.2组患者均给予常规治疗（包括腹式呼吸、缩唇呼吸和有效咳嗽、咳痰技巧训练）,观察组患者在此基础上应用呼吸训练器进行深吸气训练,每天训练4次,每次训练20 min,共训练10d（包括术前5d、术后5d）.分别于入院时、术前1d、术后第1天、术后第3天及术后第5天进行呼吸肌力量检测、血气分析、6 min步行试验（6MWT）、Borg呼吸困难评分;并于入院时、术后第5天时检测2组患者肺功能,同时运用医院焦虑抑郁量表（HADS）和诺丁汉健康量表（NHP）对2组患者进行心理功能、生活质量评估;记录2组患者术后肺部并发症发生情况.结果 入院时2组患者上述各项疗效指标组间差异均无统计学意义（P＞0.05）;术后第1天2组患者呼吸功能及运动能力均急剧下降,Borg评分明显增加,随后逐渐好转,但与入院时差异仍具有统计学意义（P＜0.05）;术后第5天时观察组患者呼吸功能[最大吸气压为（67.41±14.53） mm H2O、最大通气量为（79.83±5.37）L]、6MWT[（427.19±46.52）m]、Borg评分[（1.45±0.48）分]、术后焦虑评分[（8.14±2.80）分]、NHP总分[（128.91±25.12）分]、NHP疼痛评分[（24.66±10.12）分]、NHP睡眠评分[（25.18±9.75）分]及NHP身体活动评分[（22.81±10.72）分]均较对照组明显改善,组间差异均具有统计学意义（P＜0.05）.结论 术前及术后吸气肌训练可显著改善食管癌患者术后心肺功能,减轻术后焦虑症状,提高围手术期患者生活质量,该疗法值得临床推广、应用.Objective To investigate the effect of preoperative and postoperative inspiratory muscle training（IMT） on cardiopulmonary function and quality of life for patients undergoing esophagectomy.Methods Sixty patients who had received esophagectomy for esophageal cancer were randomly divided into an observation group （n =30） and a control group （n =30）.All of the subjects were given conventional treatment （including preoperative health education,abdominal respiration training,pursed lip respiration training and expectoration training）.On this basis,the patients in the treatment group were advised to do deep respiratory training using a breathing training device,four times a day,lasting 20 minutes each time,for 10 days （including five days before and five days after the operation）.Respiratory muscle strength,blood gases,six minute walk test （6MWT） distances and Borg dyspnea scores were measured on admission,on the day prior to the operation and on the 1st,3rd and 5th day after the operation.And also on admission and on the 5th day after the operation their pulmonary function was tested,and their psychological status and quality of life were evaluated using the hospital anxiety and depression scale （HADS） and the Nottingham health profile （NHP） respectively.Results There was no significant difference in any index between the two groups on admission（P 〉 0.05）.Everyone＆#39;s respiratory function and exercise capacity were sharply decreased,and Borg dyspnea score increased on the first postoperative day,and then gradually and significantly improved in both groups compared to that on admission（P 〈 0.05）.On the fifth postoperative day,the maximal inspiratory pressure of 67.41 ± 14.53 mmH2O,maximal ventilatory volume of 79.83 ± 5.37 L,6MWT of 427.19 ± 46.52 m,Borg score of 1.45 ± 0.48 points,postoperative anxiety score of 8.14 ±2.80 points,NHP total （128.91 ± 25.12 points）,NHP pain score （24.66 ± 10.12 points）,NHP sleeping score （25.18 ± 9.75 points）,and NHP phy

关 键 词：食管癌 吸气肌训练 肺功能 生活质量 焦虑 

分 类 号：R735.1[医药卫生—肿瘤] R614[医药卫生—临床医学]