目的:作者研究了在接受体外循环心脏手术的患者中,除了胸部理疗(CP)外,积极工作的气道正压(PAP)对肺不张(PA)的影响。
方法:随机对照研究。
方法:在单中心三级医院。
方法:80例接受心脏手术的成年患者(冠状动脉旁路移植术,瓣膜手术,或两者),并在术后第1天或第2天气管插管后出现PA,从2014年11月至2016年9月进行随机分组.
方法:三天的CP,每天两次,与积极工作相关的PAP效应(干预组)与单纯CP(对照组)。肺不张是通过使用每日胸部X线测量的放射学肺不张评分(RAS)来评估的。所有X光片都是盲目检查的。
结果:在纳入的患者中,79(99%)完成试验。主要结果是纳入后第2天的平均RAS。干预组明显较低(平均差异和95%CI:-1.1[-1.6至-0.6],p<0.001)。次要结果是在CP和临床变量之前和之后测量的鼻吸气压力。在第2天,干预组的Sniff鼻吸气压力显着升高(7.7[3.0-12.5]cmH2O,p=0.002)。干预组的呼吸频率较低(-3.2[95%CI-4.8至-1.6]呼吸/分钟,第2天p<0.001)。两组间的经皮氧饱和度/氧需求比没有发现差异,心率,疼痛,和呼吸困难评分。
结论:积极致力于PAP效应,结合CP,CP后2天接受心脏手术的患者的RAS显着降低,在临床相关参数中没有观察到差异。
The authors investigated the effect of active work with positive airway pressure (PAP) in addition to chest physiotherapy (CP) on pulmonary atelectasis (PA) in patients undergoing cardiac surgery with cardiopulmonary bypass.
A randomized controlled study.
At a single-center tertiary hospital.
Eighty adult patients undergoing cardiac surgery (coronary artery bypass grafting, valve surgery, or both), and presenting with PA after tracheal extubation on postoperative days 1 or 2, were randomized from November 2014 to September 2016.
Three days of CP, twice daily, associated with active work with PAP effect (intervention group) versus CP alone (control group). Pulmonary atelectasis was assessed by using the radiologic atelectasis score (RAS) measured from daily chest x-rays. All radiographs were reviewed blindly.
Among included patients, 79 (99%) completed the trial. The primary outcome was mean RAS on day 2 after inclusion. It was significantly lower in the intervention group (mean difference and 95% CI: -1.1 [-1.6 to -0.6], p < 0.001). The secondary outcomes were the sniff nasal inspiratory pressure measured before and after CP and clinical variables. Sniff nasal inspiratory pressure was significantly higher in the intervention group on day 2 (7.7 [3.0-12.5] cmH2O, p = 0.002). The respiratory rate was lower in the intervention group (-3.2 [95% CI -4.8 to -1.6] breaths/min, p < 0.001) on day 2. No differences were found between the 2 groups for percutaneous oxygen saturation/oxygen requirement ratio, heart rate, pain, and dyspnea scores.
Active work with the PAP effect, combined with CP, significantly decreased the RAS of patients undergoing cardiac surgery after 2 days of CP, with no differences observed in clinically relevant parameters.