术前不同呼吸训练方案结合心理干预对胸腔镜食管癌手术患者康复的影响
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摘要
目的比较术前不同呼吸训练方案结合心理干预对胸腔镜食管癌手术患者康复的影响。方法选取我院2017年2月至2018年1月120例胸腔镜食管癌手术患者为研究对象,按随机数表法分为缩唇呼吸组、吹气球组、呼吸训练器组,每组40例。三组患者入院后在常规心理干预基础上给予不同呼吸训练方案,缩唇呼吸组给予缩唇呼吸训练,吹气球组给予吹气球训练,呼吸训练器组给予呼吸训练器。检测患者血气分析指标,比较三组呼吸训练依从性与术后康复指标、肺部并发症发生率。结果呼吸训练器组完全依从率为95. 0%,显著高于缩唇呼吸组的75. 0%及吹气球组的60. 0%(P <0. 013);动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(OI)比较差异无统计学意义(P> 0. 05)。呼吸训练器组呼吸机使用时间、住院时间显著短于其他两组(P <0. 05),留置引流管时间差异无统计学意义(P> 0. 05)。三组肺部并发症总发生率比较差异无统计学意义(P=0. 115)。结论呼吸训练器可以提高胸腔镜食管癌手术患者术前呼吸训练依从性,避免术后肺功能进一步下降,加快康复进程。
Objective To compare the effect of preoperative different respiratory training programs combined with psychological intervention on the recovery of patients undergoing thoracoscopic operation for esophagus cancer.Methods We selected120 patients undergoing the thoracoscopic operation for esophagus cancer in our hospital from February 2017 to January 2018 as subjects of the study.The patients were divided into the pursed lips breathing group,balloon blowing group and breath training device group by using the random number table method,40 in each group.On the basis of routine psychological intervention,the pursed lips breathing group was given pursed lips breathing training,the balloon blowing group was given balloon blowing training and the breath training device group was given breath training device.Indexes of pulmonary function were detected and blood gas analysis was performed.The respiratory training compliance and postoperative rehabilitation indexes were compared among the three groups.The incidence rate of pulmonary complications was statistically analyzed.Results The total compliance rate of the breath training device group was 95. 0% that was significantly higher than that of the pursed lips breathing group( 75. 0%) or the balloon blowing group( 60. 0%)( P = 0. 013).However,there were no significant differences in arterial oxygen partial pressure( PaO2),arterial carbon dioxide partial pressure( PaCO2) or oxygenation index( OI) among the three groups( P > 0. 05).No significant difference in incidence of pulmonary complications was found among the three groups( P = 0. 115).Conclusion The breathing training device can improve the preoperative breathing training compliance of patients undergoing thoracoscopic operation for esophageal cancer,avoid further decline of postoperative lung function,and accelerate the patients' recovery.
Objective To compare the effect of preoperative different respiratory training programs combined with psychological intervention on the recovery of patients undergoing thoracoscopic operation for esophagus cancer.Methods We selected120 patients undergoing the thoracoscopic operation for esophagus cancer in our hospital from February 2017 to January 2018 as subjects of the study.The patients were divided into the pursed lips breathing group,balloon blowing group and breath training device group by using the random number table method,40 in each group.On the basis of routine psychological intervention,the pursed lips breathing group was given pursed lips breathing training,the balloon blowing group was given balloon blowing training and the breath training device group was given breath training device.Indexes of pulmonary function were detected and blood gas analysis was performed.The respiratory training compliance and postoperative rehabilitation indexes were compared among the three groups.The incidence rate of pulmonary complications was statistically analyzed.Results The total compliance rate of the breath training device group was 95. 0% that was significantly higher than that of the pursed lips breathing group( 75. 0%) or the balloon blowing group( 60. 0%)( P = 0. 013).However,there were no significant differences in arterial oxygen partial pressure( PaO2),arterial carbon dioxide partial pressure( PaCO2) or oxygenation index( OI) among the three groups( P > 0. 05).No significant difference in incidence of pulmonary complications was found among the three groups( P = 0. 115).Conclusion The breathing training device can improve the preoperative breathing training compliance of patients undergoing thoracoscopic operation for esophageal cancer,avoid further decline of postoperative lung function,and accelerate the patients' recovery.
引文
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[7]韩佳韫,吴俊晶,韩超.丙泊酚与右美托咪定全凭静脉麻醉对食管癌根治术患者肺氧合功能及肺部并发症的影响[J].山东医药,2017,57(5):65-67.
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[9]黄晓宇,耿明飞,周福有,等.吸气肌训练对食管癌根治术后患者心肺功能及生活质量的影响[J].中华物理医学与康复杂志,2017,39(7):539-542.
[10]温梦玲,陈冬梅,吕莹莹,等.腹式呼吸训练配合“吹龙”对脑卒中吞咽障碍患者的影响[J].广东医学,2016,37(10):1521-1523.
[11]周舟,韩小彤,宁凤玲,等.呼吸训练加振动排痰的肺康复治疗对腹部手术并发肺部感染患者的效果[J].中华危重病急救医学,2017,29(3):255-259.
[12]谌通,张凯,刘铜军.术前吹气球训练对老年结直肠癌手术患者肺功能影响的临床研究[J].中华普通外科杂志,2016,31(1):69-70.
[13]兰蕴平,吴娅秋,黎嘉嘉,等.早期呼吸训练器治疗对冠脉搭桥术后低氧血症患者肺部并发症的影响[J].中国康复理论与实践,2017,23(6):709-713.
[14]陈勇,王宝强,何潇,等.阻力呼吸器训练对肺癌放疗后患者生命质量及肺功能的影响[J].中华物理医学与康复杂志,2017,39(4):297-299.
[15]杨立新,权荣喜,于婵娟,等.肺保护通气策略在胸腹腔镜食管癌根治术中的临床价值[J].中华消化外科杂志,2016,15(11):1100-1105.
[2]秦福双.MRI对食管癌T分期诊断及手术切除中的评估价值分析[J].中国CT和MRI杂志,2018,16(1):94-97.
[3]李健,白晓鸣,冯云,等.电视辅助胸腔镜手术与传统开胸手术治疗食管胸段癌对照研究[J].中国基层医药,2016,23(10):1463-1466.
[4]汤兴松,何明学.单肺通气时间对食管癌术后急性呼吸衰竭的预防效果分析[J].湖南师范大学学报(医学版),2017,14(4):130-133.
[5]汤钊猷.现代肿瘤学(第3版)[M].上海:复旦大学出版社,2011:806-809.
[6]谭春苗,周向东,陈海燕,等.呼吸指导小组对慢性阻塞性肺疾病患者呼吸康复锻炼依从性的影响[J].广东医学,2016,37(20):3146-3148.
[7]韩佳韫,吴俊晶,韩超.丙泊酚与右美托咪定全凭静脉麻醉对食管癌根治术患者肺氧合功能及肺部并发症的影响[J].山东医药,2017,57(5):65-67.
[8]金颖,王军,吴蔚.深吸气训练在开胸手术后高龄高危患者中的应用[J].重庆医学,2017,46(6):832-834.
[9]黄晓宇,耿明飞,周福有,等.吸气肌训练对食管癌根治术后患者心肺功能及生活质量的影响[J].中华物理医学与康复杂志,2017,39(7):539-542.
[10]温梦玲,陈冬梅,吕莹莹,等.腹式呼吸训练配合“吹龙”对脑卒中吞咽障碍患者的影响[J].广东医学,2016,37(10):1521-1523.
[11]周舟,韩小彤,宁凤玲,等.呼吸训练加振动排痰的肺康复治疗对腹部手术并发肺部感染患者的效果[J].中华危重病急救医学,2017,29(3):255-259.
[12]谌通,张凯,刘铜军.术前吹气球训练对老年结直肠癌手术患者肺功能影响的临床研究[J].中华普通外科杂志,2016,31(1):69-70.
[13]兰蕴平,吴娅秋,黎嘉嘉,等.早期呼吸训练器治疗对冠脉搭桥术后低氧血症患者肺部并发症的影响[J].中国康复理论与实践,2017,23(6):709-713.
[14]陈勇,王宝强,何潇,等.阻力呼吸器训练对肺癌放疗后患者生命质量及肺功能的影响[J].中华物理医学与康复杂志,2017,39(4):297-299.
[15]杨立新,权荣喜,于婵娟,等.肺保护通气策略在胸腹腔镜食管癌根治术中的临床价值[J].中华消化外科杂志,2016,15(11):1100-1105.