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

作　　者：陈良玉 邢现良 卢蔚 刘琴[1] 胡衍辉[1] CHEN Liangyu;XING Xianliang;LU Wei;LIU Qin;HU Yanhui(Department of Anesthesiology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院麻醉科,330006

出　　处：《临床麻醉学杂志》2022年第9期906-911,共6页Journal of Clinical Anesthesiology

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/m^(2),ASAⅠ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(T_(0))、拔管后6 h(T_(1))、拔管后7 d(T_(3))测定用力肺活量(FVC)、第1秒用力呼气量(FEV_(1))和肺超声评分(LUS)。于T_(0)、拔管后3 d(T_(2))、T_(3)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(SpO_(2)≤92%)、肺不张、肺部感染等肺部并发症(PPCs)的发生情况。结果与T_(0)时比较,T_(1)时C组、P组和M组FVC、FEV_(1)明显降低(P<0.05),LUS评分明显升高(P<0.05);T_(3)时P组和M组FVC、FEV_(1)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T_(1)、T_(3)时FVC、FEV_(1)明显升高,LUS评分明显降低(P<0.05),T_(3)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T_(1)、T_(3)时FVC、FEV_(1)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。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/m^(2),ASA physical statusⅠorⅡ,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(FEV 1),and lung ultrasound score(LUS)were recorded 1 day before pre-rehabilitation exercise(T_(0)),6 hours after extubation(T_(1)),and 7 days after extubation(T_(3)).The 6-minute walk test(6MWT)was conducted and the 6-minute walk distance(6MWD)was recorded at T_(0),3 days after anesthesia extubation(T_(2)),and T_(3).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 postoper-ative hospital stay were recorded.The occurrence of postoperative pulmonary complications(PPCs)such as hypoxemia(SpO_(2)≤92%),atelectasis,and pulmonary infection were recorded within 7 days after operation.Results Compared with T_(0),FVC and FEV_(1) were significantly decreased,while LUS were significantly increased at T_(1)and T_(3)in groups C,P and M(P<0.05),FVC,FEV_(1),and 6MWD were significantly increased at T_(3)in groups P and M(P<0.05),and LUS were significantly increased at T_(3)in groups C,P and M(P<0.05).Compare

关 键 词：呼吸训练器 预康复 肥胖 肺部超声 早期恢复 

分 类 号：R614[医药卫生—麻醉学]