A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery.
A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery.
复制标题
间歇性正压呼吸、激励性肺量测定和深呼吸练习预防腹部手术后肺部并发症的对照试验。
DOI：
10.1164/arrd.1984.130.1.12
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Snider,GL
中科院分区：
文献类型：
--
作者：
Celli,BR;Rodriguez,KS;Snider,GL
在预防腹部手术后肺部并发症方面，常规使用肺扩张辅助手段存在争议。我们前瞻性地将172例患者随机分为4组：对照组(44例)不进行呼吸治疗，IPPB组(45例)接受间歇正压呼吸治疗，每天4次，IS组(42例)接受激励性肺活量测定，每天4次，DBE组(41例)在监护下进行15min的深呼吸训练，每天4次。术后24小时观察的X线改变，4组相似(20.5%~36.6%)。肺部并发症定义为出现咳嗽、痰、呼吸困难、胸痛、体温>38°C、脉率>100次/分钟等6项新发现中的3项或3项以上。肺部并发症发生率对照组为48%，IPPB组为22%(p<；0.05)，IS组为21%(p<；0.05)，DBE组为22%(p<；0.05)。呼吸治疗的副作用仅在IPPB组中观察到(18%；p<；0.05)。IS组上腹部手术患者住院时间(平均8.6±3天)明显短于对照组(13±5天)。在其他两个治疗组中没有观察到这种差异。我们得出的结论是，IPPB、IS和DBE在预防腹部手术后肺部并发症方面同样有效，尽管IS可能是上腹部手术的首选治疗方法，因为这种治疗没有并发症，而且似乎缩短了住院时间。
Controversy exists regarding the routine use of aids to lung expansion in the prevention of pulmonary complications after abdominal surgery. We prospectively randomized 172 patients into 1 of 4 groups: the control group (44 patients) received no respiratory treatment, the IPPB group (45 patients) received intermittent positive pressure breathing therapy for 15 min 4 times daily, the IS group (42 patients) was treated with incentive spirometry 4 times daily, and the DBE group (41 patients) carried out deep breathing exercises under supervision for 15 min 4 times daily. Roentgenographic changes, observed 24 h after surgery, were comparable in the 4 groups (20.5 to 36.6%). Pulmonary complications were defined as the development of 3 or more of 6 new findings: cough, phlegm, dyspnea, chest pain, temperature greater than 38° C, pulse rate more than 100 beats/min. The frequency of development of pulmonary complications was 48% in the control group, 22% in the IPPB group (p < 0.05), 21% in the IS group (p < 0.05), and 22% in the DBE group (p < 0.05). Side effects of respiratory treatment were observed only in the IPPB group (18%; p < 0.05). Hospital stay in patients undergoing upper abdominal surgery was significantly shorter in the IS group (mean ± SD, 8.6 ± 3 days) than in the control group (13 ± 5 days). This difference was not observed for the other 2 treatment groups. We conclude that IPPB, IS, and DBE were equally effective in preventing pulmonary complications after abdominal surgery, although IS may be the treatment of choice in upper abdominal procedures, because there are no complications of this treatment and it appears to shorten the length of hospitalization.