术前呼吸肌训练对吸气肌无力者冠状动脉旁路移植术预后的影响
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摘要
目的:探讨术前呼吸肌训练对伴有吸气肌无力的(inspiratory muscle weakness,IMW)患者冠状动脉旁路移植术(CABG)后恢复的影响。方法:研究对象为2016-01-2017-01于北京大学第三医院心外科行CABG的99例患者,所有患者术前均接受最大吸气压(maximal inspiratory pressure,MIP)测定,根据MIP占预计值(predicted normal value,PNV)的百分比将患者分为IMW组(MIP/PNV<70%)和对照组(吸气肌肌力正常,MIP/PNV≥70%),术前指导IMW患者应用呼吸训练器进行呼吸肌训练,比较2组患者术后机械通气时间、ICU住院时间、术后住院时间、住院病死率、术后6min步行测试及术后并发症等方面的差异。结果:99例患者中共纳入IMW组21例,对照组78例;IMW组患者全部存活出院,对照组中2例患者死亡,差异有统计学意义;IMW组ICU停留时间显著缩短(P<0.05),且呼吸机辅助通气时间和术后住院时间并无明显延长(P>0.05);术后6min步行测试及术后并发症方面2组间无明显差异。结论:针对存在IMW的患者术前进行呼吸肌训练可明显改善CABG患者的预后。
Objective:To investigate the effects of preoperative inspiratory muscle training(IMT)in inspiratory muscle weakness(IMW)patients referred for CABG.Method:From January 2016 to January 2017,99 consecutive IMT patients undergoing CABG were observed.All subjects received MIP(maximal inspiratory pressure,MIP)test and were divided into weak inspiratory muscle group(MIP/PNV<70%)and control group(MIP/PNV≥70%)according to their MIP/PNV(predicted normal value,PNV)ratio.The duration of mechanical ventilation,the length of ICU or hospital stay,in-hospital mortality rate,postoperative 6-minute walk test(6 MWT)and postoperative complications were compared between these two groups.Result:A total of 21 cases in IMT group amd 78 cases in control group were included.Hospital mortality and ICU stay time was decreased significantly in IMT group.Mechanical ventilation support time,postoperative hospital stay time,postoperative-6 MWT and postoperative complications had no significant difference between the two groups.Conclusion:Preoperative IMT could improve the prognosis of patients with inspiratory muscle weakness referred for CABG.
Objective:To investigate the effects of preoperative inspiratory muscle training(IMT)in inspiratory muscle weakness(IMW)patients referred for CABG.Method:From January 2016 to January 2017,99 consecutive IMT patients undergoing CABG were observed.All subjects received MIP(maximal inspiratory pressure,MIP)test and were divided into weak inspiratory muscle group(MIP/PNV<70%)and control group(MIP/PNV≥70%)according to their MIP/PNV(predicted normal value,PNV)ratio.The duration of mechanical ventilation,the length of ICU or hospital stay,in-hospital mortality rate,postoperative 6-minute walk test(6 MWT)and postoperative complications were compared between these two groups.Result:A total of 21 cases in IMT group amd 78 cases in control group were included.Hospital mortality and ICU stay time was decreased significantly in IMT group.Mechanical ventilation support time,postoperative hospital stay time,postoperative-6 MWT and postoperative complications had no significant difference between the two groups.Conclusion:Preoperative IMT could improve the prognosis of patients with inspiratory muscle weakness referred for CABG.
引文
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[12]Montemezzo D,Fregonezi GA,Pereira DA,et al.Influence of inspiratory muscle weakness on inspiratory muscle training responses in chronic heart failure patients:a systematic review and meta-analysis[J].Arch Phys Med Rehabil,2014,95(7):1398-1407.
[13]ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories.ATS statement:guidelines for the six-minute walk test[J].Am J Respir Crit Care Med,2002,166(1):111-117.
[14]Ribeiro JP,Chiappa GR,Callegaro CC.The contribution of inspiratory muscles function to exercise limitation in heart failure:pathophysiological mechanisms[J].Rev Bras Fisioter,2012,16(4):261-267.
[15]Harms CA,Wetter TJ,ST Croix CM,et al.Effects of respiratory muscle work on exercise performance[J].J Appl Physiol,2000,89(1):131-138.
[16]Miller JD,Smith CA,Hemauer SJ,et al.The effects of inspiratory intrathoracic pressure production on the cardiovascular response to submaximal exercise in health and chronic heart failure[J].Am J Physiol Heart Circ Physiol,2007,292(1):H580-H592.
[17]Basso-Vanelli RP,Di Lorenzo VA,Labadessa IG,et al.Effects of inspiratory muscle training and Calisthenics-and-Breathing exercises in COPD with and without respiratory muscle weakness[J].Respir Care,2016,61(1):50-60.
[18]Beaumont M,Mialon P,Ber-Moy CL,et al.Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease:A randomized trial[J].ChronRespir Dis,2015,12(4):305-312.
[19]Majewska-Pulsakowska M,Wytrychowski K,Ro6)zekPiechura K.The Role of Inspiratory Muscle Training in the Process of Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease[J].Adv Exp Med Biol,2016,885(4):47-51.
[20]Gosker HR,Engelen MP,Van Mameren H,et al.Muscle fiber typeⅡⅩatrophy is involved in the loss of fat-free mass in chronic obstructive pulmonary disease[J].Am J Clin Nutr,2002,76(1):113-119.
[2]李玉倩,郑宏,俞瑾,等.七氟醚后处理在再灌注早期心肌保护作用[J].临床心血管病杂志,2017,33(11):1054-1057.
[3]Fatigue RM.NHLBI Workshop Summary[J].Am Rev Respir Dis,1990,142:474-480.
[4]McConnell AK,Copestake AJ.Maximum static respiratory pressures in healthy elderly men and women:issues of reproducibility and interpretation[J].Respiration,1999,66(3):251-258.
[5]Dall'Ago P,Chiappa GRS,Guths H,et al.Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness:a randomized trial[J].J Am Coll Cardiol,2006,47(4):757-763.
[6]Carpenter MA,Tockman MS,Hutchinson RG,et al.Demographic and anthropometric correlates of maximum inspiratory pressure:The Atherosclerosis Risk in Communities Study[J].Am J Respir Crit Care Med,1999,159(2):415-422.
[7]Wilson SH,Cooke NT,Edwards RH,et al.Predicted normal values for maximal respiratory pressures in caucasian adults and children[J].Thorax,1984,39(7):535-538.
[8]Hulzebos EH,Helders PJ,Favie NJ,et al.Preoperative Intensive Inspiratory Muscle Training to Prevent Postoperative Pulmonary Complications in High-Risk Patients Undergoing CABG Surgery:A Randomized Clinical Trial[J].JAMA,2006,296(15):1851-1857.
[9]Toumpoulis IK,Anagnostopoulos CE,Balaram SK,et al.Assessment of independent predictors for long-term mortality between women and men after coronary artery bypass grafting:Are women different from men?[J].J Thorac Cardiovasc Surg,2006,131(2):343-351.
[10]Herdy AH,Marcchi PL,Vila A,et al.Pre-and postoperative cardiopulmonary rehilitation hospitalized patients undergoing coronary artery bypass surgery:a randomized controlled trial[J].Am J Phys Med Rehabil,2008,87(9):714-719.
[11]Smart NA,Giallauria F,Dieberg G.Efficacy of inspiratory muscle training in chronic heart failure patients:a systematic review and meta-analysis[J].Int J Cardiol,2013,167(4):1502-1507.
[12]Montemezzo D,Fregonezi GA,Pereira DA,et al.Influence of inspiratory muscle weakness on inspiratory muscle training responses in chronic heart failure patients:a systematic review and meta-analysis[J].Arch Phys Med Rehabil,2014,95(7):1398-1407.
[13]ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories.ATS statement:guidelines for the six-minute walk test[J].Am J Respir Crit Care Med,2002,166(1):111-117.
[14]Ribeiro JP,Chiappa GR,Callegaro CC.The contribution of inspiratory muscles function to exercise limitation in heart failure:pathophysiological mechanisms[J].Rev Bras Fisioter,2012,16(4):261-267.
[15]Harms CA,Wetter TJ,ST Croix CM,et al.Effects of respiratory muscle work on exercise performance[J].J Appl Physiol,2000,89(1):131-138.
[16]Miller JD,Smith CA,Hemauer SJ,et al.The effects of inspiratory intrathoracic pressure production on the cardiovascular response to submaximal exercise in health and chronic heart failure[J].Am J Physiol Heart Circ Physiol,2007,292(1):H580-H592.
[17]Basso-Vanelli RP,Di Lorenzo VA,Labadessa IG,et al.Effects of inspiratory muscle training and Calisthenics-and-Breathing exercises in COPD with and without respiratory muscle weakness[J].Respir Care,2016,61(1):50-60.
[18]Beaumont M,Mialon P,Ber-Moy CL,et al.Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease:A randomized trial[J].ChronRespir Dis,2015,12(4):305-312.
[19]Majewska-Pulsakowska M,Wytrychowski K,Ro6)zekPiechura K.The Role of Inspiratory Muscle Training in the Process of Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease[J].Adv Exp Med Biol,2016,885(4):47-51.
[20]Gosker HR,Engelen MP,Van Mameren H,et al.Muscle fiber typeⅡⅩatrophy is involved in the loss of fat-free mass in chronic obstructive pulmonary disease[J].Am J Clin Nutr,2002,76(1):113-119.