术前呼吸肌训练对心脏瓣膜置换术吸气肌无力患者预后的影响  

Effect of Preoperative Inspiratory Muscle Training on Postoperative Recovery in Inspiratory Muscle Weakness Patients Referred for Cardiac Valve Replacement

作　　者：许志锋[1] 吴桂琴[1] 吴永前[1] 丘汉斌 陈周珍 高欢 XU Zhifeng;WU Guiqin;WU Yongqian;QIU Hanbin;CHEN Zhouzhen;GAO Huan(Department of Cardiovascular Surgery,Peking University ShenZhen Hospital,ShenZhen,Guangdong 518000,China)

机构地区：[1]北京大学深圳医院心血管外科,广东深圳518000

出　　处：《岭南心血管病杂志》2023年第4期380-384,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨术前呼吸肌训练对心脏瓣膜病合并吸气肌无力(inspiratory muscle weakness,IMW)患者行双瓣膜置换术术后恢复的影响。方法入选2019年1月至2021年1月于北京大学深圳医院心血管外科行正中开胸体外循环心脏双瓣膜置换(二尖瓣+主动脉瓣)手术的患者165例,收集患者住院临床资料。所有患者入院后均接受最大吸气压(maximal inspiratory pressure,MIP)测定,根据MIP占预计正常值(predicted normal value,PNV)的百分比分为IMW组(MIP/PNV<70%)及对照组(MIP/PNV≥70%)。IMW组患者根据入院顺序兼顾患者意愿分为IMW1组及IMW2组。所有患者在术前1~2周开始进行有效咳嗽、咳痰技巧等基础训练。IMW1组在有基础训练上加强氧疗、雾化吸入治疗。IMW2组在1组基础上应用呼吸训练器(POWER breathe K5)进行呼吸肌最大吸力专项训练。应用倾向性评分匹配法,按1∶1比例从对照组中筛选年龄、性别、体质量指数、左心室射血分数(LVEF)等临床基线资料与IMW组相匹配的患者进行统计分析,比较3组患者术后机械通气时间、重症监护病房(intensive care unit,ICU)停留时间、术后住院时间以及术后并发症、住院病死率等方面的差异。结果入选IMW患者45例(IMW1组21例,IMW2组24例),对照组120例。经倾向性评分匹配,匹配后对照组患者45例,其临床基线水平与IMW组一致(P>0.05)。入选患者均存活出院,无严重肝、脑重要脏器功能障碍并发症。IMW1组术后新发心房颤动1例(4.8%),IMW2组无新发心房颤动发生,匹配后对照组新发心房颤动2例(4.2%),3组比较差异无统计学意义(P>0.05)。3组患者术后呼吸机辅助通气时间、ICU停留时间及术后住院时间比较,差异有统计学意义(P<0.05);IMW1组与对照组及IMW2组相比,术后呼吸机辅助通气时间[(34.7±12.6)min vs.(25.4±9.3)min vs.(21.3±10.3)min,P<0.05]及ICU停留时间[(96.4±39.5)min vs.(70.2±44.3)min vs.(69.8±30.7)min,P<0.05]更长,术后住院�Objectives To investigate the effects of preoperative inspiratory muscle training(IMT)in inspiratory muscle weakness(IMW)patients referred for double cardiac valve replacement(DVR)surgery.Methods From January 2019 to January 2021,characteristics of 165 consecutive patients undergoing DVR in Peking University ShenZhen Hospital were observed.All the subjects received maximal inspiratory pressure(MIP)test and were divided into 2 groups:weak inspiratory muscle group[IMW group,MIP/predicted normal value(PNV)<70%]and control group(MIP/PNV≥70%),according to their MIP/PNV ratio.Subjects of IMW group were divided into IMW group 1 and IMW group 2 according to the order of admission and the wishes of patients.All the patients received effective training of cough and expectoration skills 1-2 weeks before operation.IMW group 1 received additional strengthening of oxygen therapy and nebulized inhala⁃tion therapy.IMW group 2,except for taken the same treatments of IMW group 1,received specific training on maximal inspiratory capacity of respiratory muscles by applying a breathing trainer(power breathe K5).Patients with clinical baseline data such as age,gender,body mass index and left ventricular ejection fraction(LVEF)matched with IMW group were selected from control group according to the ratio of 1∶1 for statistical analysis,by using propensity score matching method.The differences in the duration of mechanical ventilation,the duration of intensive care unit(ICU)stay or the duration of hospital stay,in-hospital mortality rate and postoperative complications were compared among the three groups.Results A total of 45 patients in IMW group and 120 patients in control group were enrolled,and 45 patients in control group were matched by propensity score as a new matched-control group.There was no significant difference in general clinical characteristics between IMT group and matched-control group(P>0.05).All the enrolled patients survived to hospital discharge without major complication of liver or brain dysfunction.There

关 键 词：心脏瓣膜病 双瓣置换术 吸气肌无力 呼吸功能锻炼 

分 类 号：R542.5[医药卫生—心血管疾病]