马宵宵,王朝辉,金鑫鑫,等.精准化气道管理策略对心脏外科术后患者肺部功能和并发症的影响[J].中华物理医学与康复杂志,2025,47(11):991-997
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| 精准化气道管理策略对心脏外科术后患者肺部功能和并发症的影响 |
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| DOI：10.3760/cma.j.cn421666-20250407-00307 |
| 中文关键词: 心脏术后 气道管理 主动呼吸循环技术 振荡正压呼气技术 肺部并发症 RALE评分 |
| 英文关键词: Cardiac surgery Airway management Breathing techniques Oscillatory positive expiratory pressure technique Pulmonary complications RALE scoring |
| 基金项目:浙江省医药卫生科技计划项目（2024XY068）；浙江省医药卫生科技计划项目（2021KY503） |
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| 中文摘要: |
| 目的 比较主动呼吸循环技术（ACBT）和振荡正压呼气技术（OPEP）对心脏术后患者肺功能恢复和肺部并发症的干预效果，探讨术后患者精准化气道管理的策略。 方法 采用随机数字表法将101例心脏术后患者分为ACBT组50例和OPEP组51例。术后第一天开始，2组患者均接受常规医疗方案和早期康复，ACBT组在此上增加ACBT训练，OPEP组则增加OPEP训练，2种训练方法均每日1次，每次20 min，连续训练7 d。于术前、术后第3天、术后第7天采用肺水肿影像学评分（RALE）、CT影像和肺功能指标评估2组患者肺部的并发症和功能，同时采用6 min步行距离、Barthel指数和散射比浊法分别评估或检测2组患者的运动耐力、日常生活活动能力和C-反应蛋白，并记录2组患者的机械通气时间、ICU停留时间、术后住院天数和总住院天数。 结果 术后第7天，ACBT组和OPEP组的RALE评分分别为（12.40±4.37）分和（10.20±4.66）分，组间差异均有统计学意义(P<0.05)。术后第3天，ACBT组的肺实变发生率较OPEP组显著下降(P<0.05)；术后第7天，OPEP组的肺不张发生率较ACBT组显著下降(P<0.05)。术后第7天，OPEP组患者的最大吸气压占预计值百分比（MIP%）较ACBT组显著提升(P<0.05)。术后第7天，OPEP组的6 min步行试验距离、BI评分较ACBT组显著改善。 结论 术后第3天，ACBT的疗效优于OPEP，至术后第7天，OPEP对心脏术后患者呼吸肌力和肺部并发症的疗效则优于ACBT，因此建议分阶段应用ACBT和OPEP技术来优化心脏术后患者的气道管理策略，且RALE评分是动态监测心脏术后肺部并发症的理想工具。 |
| 英文摘要: |
| Objective To compare the active respiratory circulation technique (ACBT) with the oscillatory positive pressure expiration technique (OPEP) in terms of their ability to improve pulmonary function and minimize complications after cardiac surgery, seeking to define an airway management strategy for such patients. Methods A total of 101 patients who had undergone cardiac surgery were randomly divided into an ACBT group (n=50) and an OPEP group (n=51). On the 1st day after the operation, in addition to conventional medical treatment and early rehabilitation, the subjects were additionally provided with daily 20-minute sessions of ACBT or OPEP training for seven consecutive days. Before the operation, and on the 3rd and 7th day afterward, lung function was assessed using a pulmonary edema imaging assessment system (RALE), computed tomography and pulmonary function indexes. Any complications were also noted. Six-minute walking distance and the Barthel index quantified exercise endurance and ability in the activities of daily living, respectively. Turbidimetry was used to determine the levels of C-reactive protein in the blood. The duration of mechanical ventilation required, ICU stay time, length of postoperative and total hospital stays were also recorded. Results On day seven after the operation, the average RALE scores of the ACBT and OPEP groups were (12.40±4.37) and (10.20±4.66), respectively—a significant difference. At the same time point, the incidence of atelectasis in the OPEP group was significantly lower than in the ACBT group. The OPEP group′s average maximum inspiratory pressure was a greater percentage of the predicted value, and its average 6-minute walk and BI score were also better. On the 3rd day after the operation, the incidence of lung consolidation in the ACBT group was significantly lower than that in the OPEP group, on average. Conclusions The curative effect of ACBT is better than that of OPEP in the first few days after such an operation, but after a week OPEP more effectively restores respiratory muscle strength and relieves pulmonary complications. It is recommended to apply these two techniques in stages to optimize postoperative airway management. RALE scoring is an ideal tool for dynamic monitoring of pulmonary complications after cardiac surgery. |
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