有限资源下创新性吸气肌训练方案对心脏瓣膜疾病患者术后肺部并发症的影响

关键词：吸气肌训练  术后肺部并发症  心脏瓣膜病  预康复  心脏手术

Keywords:inspiratory muscle training  postoperative pulmonary complications  valvular heart disease  pre-rehabilitation  cardiac surgery

摘要：

      摘要 目的：探究有限资源下匹配中国心脏瓣膜疾病患者术前等待时间的强化吸气肌训练方案对预防术后肺部并发症的有效性和可行性。 方法：以择期心脏瓣膜手术患者为研究对象，随机分为对照组和干预组，每组各65例。所有入组患者术前均接受常规物理治疗干预方案，干预组额外增加术前3天的强化吸气肌训练。术后14天内，对所有患者进行术后并发症发生率的记录，在入院和出院当天对所有患者进行呼吸功能和运动能力测试，并统计患者术后住院时长。 结果：治疗前两组患者一般人口学特征无显著性差异。经术前3天强化吸气肌训练后，干预组术后肺部并发症（postoperative pulmonary complications， PPCs）发生率低于对照组（P=0.03），出院时6min步行距离高于对照组（P=0.01），而出院时的肺功能与术后住院时间与对照组比较无显著性差异（P>0.05），训练期间无任何不良事件发生。 结论：术前3天强化吸气肌训练方案在择期心脏瓣膜患者中是安全可行的，能够减少术后肺部并发症的发生和改善患者出院时的运动功能水平。

Abstract:

      Abstract Objective： To explore the effectiveness and feasibility of strengthening inspiratory muscle training program matching the preoperative waiting time for patients with valvular heart disease in China with limited resources in preventing postoperative pulmonary complications（PPCs）. Method： Patients undergoing elective heart valve surgery were randomly divided into control group and intervention group, with 65 patients in each group. All the enrolled patients received a routine physical therapy program before surgery, and the intervention group received an additional 3 days of enhanced inspiratory muscle training program before surgery. The incidence of postoperative complications was recorded for all patients within 14 days after surgery， respiratory function and motor capacity （6-minute walking test） were tested for all patients on the day of admission and discharge， and the length of postoperative hospital stay was counted. Result： Compared with the control group， the incidence of PPCs was lower in the intervention group （OR 2.18， 95%CI 1.07—4.47， P=0.03）， and the walking distance was longer （P=0.01）. There was no statistical difference in lung function and length of hospital stay （P>0.05）， and no adverse events occurred during training. There was no significant difference in general demographic characteristics between the two groups before treatment. The incidence of PPCs in the intervention group was lower than that in the control group （P<0.05）， and the 6-minute walking distance at discharge was higher than that in the control group （P<0.05）. There were no statistically significant differences in lung function and postoperative hospital stay between the intervention group and the control group （P>0.05）， and no adverse events occurred during training. Conclusion： Enhanced inspiratory muscle training 3 days before surgery is safe and feasible in patients with elective heart valves and can reduce postoperative pulmonary complications and improve the level of motor function at discharge.