背景:心脏直视手术,涉及正中胸骨切开术,术后早期可能导致胸壁运动减弱和肺功能受限。通常建议在手术后进行胸部和上肢运动范围(ROM)锻炼,但尚未评估对肺容量和氧合的影响。这项研究的目的是评估上肢抬高的即时效果,有或没有同时深呼吸,心脏手术后的肺功能。
方法:在一项随机的2×2交叉试验中,2022年春季,厄勒布罗大学医院在手术后的第一天对22名成年患者(>18岁)进行了评估,瑞典。涉及五个双侧上肢抬高的练习,同时进行深呼吸(ROM-DB)或不进行深呼吸(ROM),当直立坐在床边时,进行了评估。外周血氧饱和度(Rad-5v;Masimo,Irvine,美国)是主要结果。在运动过程中连续记录潮气量和呼吸频率(Spiropalm;Cosmed,罗马,意大利)。心率,疼痛,运动前后评估劳累和呼吸困难。
结果:ROM-DB和ROM都暂时增加了外周血氧饱和度(分别为+1%±1,p=0.004和+1%±1,p<0.001),这些练习之间没有显着差异(p=0.525)。与ROM相比,ROM-DB显着增加了VT(798±316与602毫升±176,p=0.004)。然而,ROM-DB引起更明显的疼痛(p=0.012),劳力(p=0.035)和呼吸困难(p=0.013)比ROM。
结论:上肢抬高可瞬间改善氧合,都是在有和没有同时深呼吸的情况下进行的,这些练习之间没有显着差异。与仅上肢抬高相比,加性深呼吸改善了潮气量,但引起了更多的疼痛,运动期间的劳累和呼吸困难。
背景:ClinicalTrials.gov(NCT05278819)。
BACKGROUND: Open heart surgery, involving median sternotomy, may cause diminished chest wall motion and restrictive pulmonary function in the early postoperative period. Thoracic and upper extremity range of motion (ROM) exercises are often recommended after surgery but have not been evaluated regarding effect on lung volumes and oxygenation. The objective of this
study was to evaluate the immediate effect of upper limb elevations, with or without simultaneous deep breathing, on lung function after cardiac surgery.
METHODS: In a randomized 2 × 2 crossover
trial, 22 adult patients (> 18 years old) were assessed during one of the first days after surgery in the spring of 2022 at Örebro University Hospital, Sweden. Exercises involving five bilateral upper limb elevations, performed either with simultaneous deep breathing (ROM-DB) or without (ROM), while sitting in an upright position at the edge of the bed, were evaluated. Peripheral oxygen saturation (Rad-5v; Masimo, Irvine, USA) was the primary outcome. Tidal volume and respiratory rate were recorded continuously during the exercises (Spiropalm; Cosmed, Rome, Italy). Heart rate, pain, exertion and dyspnoea were evaluated before and after the exercises.
RESULTS: Both ROM-DB and ROM momentarily increased peripheral oxygen saturation (+ 1% ± 1, p = 0.004 and + 1% ± 1, p < 0.001, respectively), with no significant differences between these exercises (p = 0.525). ROM-DB significantly increased the VT compared with ROM (798 ± 316 vs. 602 mL ± 176, p = 0.004). However, ROM-DB induced more pronounced pain (p = 0.012), exertion (p = 0.035) and dyspnoea (p = 0.013) than ROM.
CONCLUSIONS: Upper limb elevations improved oxygenation momentarily, both performed with and without simultaneous deep breathing, with no significant differences between these exercises. The additive deep breathing improved tidal volume compared with upper limb elevations alone, but induced more pain, exertion and dyspnoea during the performance of exercise.
BACKGROUND: ClinicalTrials.gov (NCT05278819).