深呼吸训练器对老年上腹部手术后肺部并发症疗效的观察与评价  

Observation and evaluation of deep breathing trainer used for postoperative pulmonary complications in elderly patients with upper abdominal surgery

作　　者：沈徐 沈淇洪 高洁彦 周煦燕 SHEN Xu;SHEN Qi-hong;GAO Jie-yan;ZHOU Xu-yan(Department of Anesthesiology,the First Hospital of Jiaxing,Jiaxing,Zhejiang 314000,China)

机构地区：[1]嘉兴市第一医院麻醉与疼痛医学中心,浙江嘉兴314000

出　　处：《中华全科医学》2020年第4期581-584,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2016KYB285);浙江省浙北区域麻醉专病中心基金(201524)。

摘　　要：目的观察与评价在围术期使用深呼吸训练器对缓解择期行上腹部手术的老年患者术后肺部并发症的疗效。方法纳入2017年1-12月期间在嘉兴市第一医院择期行上腹部手术的老年患者100例,采用随机数字表法分为研究组和对照组,每组各50例。在围术期(术前5 d~术后7 d),对照组采用手术常规干预,研究组在对照组常规干预的基础上,于术前5 d~术后7 d(术后6 h开始训练)使用深呼吸训练器给予呼吸功能锻炼的强化干预。临床观察指标:术前(5 d、1 d)、术后(1 d、4 d、7 d)的用力肺活量(FVC)、1 s呼气量(FEV1)及最大深吸气量(IC)、氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2)。同时麻醉医生使用改良床旁肺部超声(improvement of bedside ultrasound lung examination protocol,BLUE)方案在床边进行动态检查,观察有无肺膨胀不全、肺部感染等肺部并发症。结果与对照组相比,观察组术后FVC、FEV1、IC水平均明显升高,PaO2、PaCO2、SaO2水平均明显改善;术后发生肺不张及肺部感染的例数明显少于对照组,平均住院时间也较短。结论使用深呼吸训练器对老年患者在围手术期(术前、术后)进行呼吸功能锻炼,能确切有效的改善老年患者的肺功能,从而降低上腹部手术后肺部并发症的发生率,提高了围手术期患者的生活质量,对促进快速康复有重要意义。Objective To observe and evaluate the effect of a deep breathing trainer during perioperative period on postoperative pulmonary complications in elderly patients with elective upper abdominal surgery. Methods From January to December 2017, 100 elderly patients with upper abdominal surgery in our hospital were selected and randomly divided into study group and control group, with 50 cases in each group. During the perioperative period(5 days before operation-7 days after operation), the control group was given routine surgical intervention, while on the basis of the control group, the study group received intensive intervention of respiratory function exercise with deep breathing trainer 5 days before operation to 7 days after operation(6 hours after operation). Clinical observation index included forced vital capacity(FVC), 1 s expiratory volume(FEV1), maximum deep inspiration volume(IC), partial pressure of oxygen(PaO2), partial pressure of carbon dioxide(PaCO2), blood oxygen saturation(SaO2) at the time points of preoperative(5 d, 1 d) and postoperative(1 d, 4 d, 7 d). At the same time, the anesthesiologist used the improved bedside ultrasound lung examination protocol(BLUE) method to dynamic examination at beside, to observe whether there were pulmonary complications such as pulmonary insufficiency and pulmonary infection. Results Compared with control group, the levels of FVC, FEV1 and IC in the observation group were significantly increased, and the indexes of PaO2, PaCO2 and SaO2 were significantly improved. The incidence rate of postoperative atelectasis and pulmonary infection in the observation group was significantly less than that of the control group, and the average length of stay was shorter. Conclusion The use of deep breathing trainer in elderly patients during the perioperative period can effectively improve the lung function, reduce the incidence of postoperative pulmonary complications, improve the quality of patient’s life, and has great significance to promote rapid recovery.

关 键 词：深呼吸训练器 老年患者 术后肺部并发症 

分 类 号：R656[医药卫生—外科学] R619[医药卫生—临床医学]