术前呼吸功能锻炼对减少体外循环手术呼吸系统并发症作用.docVIP

术前呼吸功能锻炼对减少体外循环手术呼吸系统并发症作用【摘要】目的:探讨心脏外科体外循环手术前行呼吸功能锻炼，对减少术后呼吸系统并发症的作用。方法对2009年12月- 2010年2月心脏外科行体外循环手术的患者187例，随机分为两组,其中一组于入院时即给予呼吸功能锻炼，包括戒烟、腹式呼吸、咳嗽训练、呼吸训练器的使用、呼吸道解痉祛痰等，两组均接受常规检查，并在体外循环下行心内直视手术治疗。比较两组患者术后呼吸系统观察项目的差异性,并进行方差分析。结果187例患者术后死亡2例，其余患者均顺利出院。其中19例出现呼吸系统并发症,两组比较结果显示,术前行呼吸功能锻炼组与常规治疗组在机械通气时间、术后应用抗菌素时间、术后住院时间、气管切开、肺不张、ARDS、医院获得性肺炎等指标差异有统计学意义;结论心脏外科体外循环术前给予严密的呼吸功能锻炼,可减少患者术后呼吸系统并发症发生,促进患者术后康复 【关键词】体外循环手术; 呼吸功能锻炼; 呼吸系统并发症 【中国分类号】R473.6【文献标识码】A【文章编号】1044-5511（2011）10-0019-02 【Abstract】Objective:Investigate the effect of respiratory training in reducing respiratory complications , on those who received cardiopulmonary bypass surgery.Methods:We perform operation to 187 heart disease patients under cardiopulmonary bypass during the 2009.12-2010.2. We randomly divided into two groups. One group is given to the respiratory training at the time of admission. Including smoking cessation, abdominal breathing, cough training, respiratory expectorant, Et cetera. Both groups received routine examination, and heart surgery under cardiopulmonary bypass. Compare the postoperative respiratory observed differences in the project, Carry out Analysis of variance.Results: Two deaths in 187 patients. The remaining patients were discharged. 19 patients of them had respiratory complications. The results showed that there are differencesbetween the groups ofrespiratory training and conventional treatment groups significantly in mechanical ventilation time，postoperative antibiotics time，hospital stay，tracheotomy，atelectasis，ARDS，hospital acquired pneumonia.Conclusion：Giving respiratory training strictly before cardiac surgery cardiopulmonary bypass, could reduce postoperative respiratory complications and promote the rehabilitation of patients 【Key words】Cardiopulmonary bypass; Respiratory training; Respiratory complications. 肺炎、肺不张和术后的呼吸功能不全是心脏手术后最常见的并发症,心内直视手术患者在术前、术后的免疫功能与正常人均有明显差异,处于易感染状态中[1];同时心脏手术需经过体外循环过程、术中肺泡处于萎陷状态、围手术期各种侵入性操作多，术后切口创伤大疼痛明显,均大大增加术后呼吸系统并发症的风险。除了手术的因素，这些并发