Alis KOSTANOĞLU, Ela TARAKCI, Enver DAYIOĞLU, Sabriye DEMİRCİ

Torasik cerrahi sonrası postoperatif pulmoner komplikasyonların önlenmesinde İnsentif spirometre ve Continous Positive Airway Pressure (CPAP)'ın karşılaştırılması

Amaç: Torasik cerrahi geçiren hastalarda İnsentif spirometre ve devamlı pozitif havayolu basıncı- Continuous Positive Airway Pressure maskesinin postoperatif pulmoner komplikasyonlar üzerine etkisinin araştırılması. Gereç ve Yöntemler: Çalışmaya torasik cerrahi geçiren hemodinamik açıdan stabil, yaşları 16-75 arasında değişen 14’ü kadın, 16’sı erkek toplam 30 hasta dahil edildi. Hastalar ekstübasyonu takiben randomize olarak iki gruba ayrıldı. 1. grupla “İnsentif Spirometre” çalışmaları, 2. grupla ise “CPAP uygulaması” yapıldı. Tüm olguların postoperatif birinci ve dokuzuncu günde arter kan gazları, solunum fonksiyon testleri ve akciğer radyolojik incelemesi yapıldı ve sonuçlar karşılaştırıldı. Bulgular: Olgularla çalışmaya başlandıktan sonra postoperatif birinci ve dokuzuncu günde yapılan arter kan gazı sonuçları gruplar arası farklı bulunmadı (p > 0.05) Her iki gruptaki hastaların Zorlu Vital Kapasite-Forced Vital Capacity (FVC), birinci saniyede Zorlu Ekspirasyon Volümü-Forced Expiratory Volume 1 second (FEV1), ve Zorlu Eksipratuar Akım-Forced Expiratory Flow (FEF %25-75) değerlerinde postoperatif dokuzuncu günde preoperatif ölçüm değerlerine göre istatistiksel olarak anlamlı düzeyde azalmalar tespit edildi (p < 0.001). Ancak postoperatif birinci gün ile dokuzuncu gün solunum fonksiyon testleri karşılaştırıldığında ise dokuzuncu günde her iki gurupta da anlamlı düzelmeler başladı (p < 0.001). Solunum fonksiyon testlerinin tüm parametrelerinde gözlenen bu düzelmenin gruplar arasında istatistiksel olarak anlamlı fark oluşturmadığı görüldü (p > 0.05). Akciğer radyolojik incelemesinde de tedavi sonrası iki grup arasında istatistiksel olarak anlamlı fark mevcut değildi (p > 0.05). Sonuç: Torasik cerrahi geçiren hastalarda solunum performansını geliştirmek için mekanik fizyoterapi teknikleri etkilidir. İnsentif Spirometre ve CPAP uygulamasının pulmoner komplikasyonları önleme açısından birbirlerine üstünlükleri yoktur.

Anahtar Kelimeler:

Toraks cerrahisi, insentif spirometre, Continuous positive airway pressure, solunum fonksiyon testleri, fizyoterapi

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Abstrac Aim: Investigating effects of Incentive Spirometry and Continuous Positive Airway Pressure (CPAP) masks on postoperative pulmonary complications in patients who were undergone thoracicsurgery. Material and Methods: The study enrolled totally 30 patients, including 14 female and 16 male patients, who were hemodynamically stable following thoracic surgery. Following the extubation, patients were randomly divided into two groups. “Incentive Spirometry” studies were performed with group 1, while “CPAP” studies were performed with group 2. For all cases, arterial blood gases analysis, respiratory functions tests and pulmonary X-ray examinations were performed at post- operative first and ninth days. Results: Following the onset of study, no difference could be found in arterial blood gases results performed at post-operative first and ninth days (p>0.05). In both groups, statistically significant decrease in Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1) and Forced Expiratory Flow values measured at post-operative ninth days was found in comparison with pre-operative measurement values (p<0.001). However, pulmonary function tests were compared postoperative first the ninth days and significant improvements in both groups began ninth day (p<0.001). It was observed that the improvement found in all parameters of respiratory function tests did not have statistically significant differences (p>0.05). In the pulmonary X-ray examination, there was not statistically significant difference between two groups following the therapy (p>0.05). Conclusion: Mechanic physiotherapy techniques are efficient for improving respiratory performance in patients who are undergoing thoracic surgery. Incentive Spirometry and CPAP are not superior to each other on preventing pulmonary complications

Keywords:

Thoracic surgery; Incentive Spirometry; Positive Airway Pressure; pulmonary function tests; physiotherapy,

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KAYNAKLAR
Ferguson MK. Preoperative assessment of pulmonary risk. Chest 1999;115: 58-63.
Hall JC, Talala RA, Mander J. A multivariate analysis of the risk of pulmonary complications after laparatomy. Chest 1991;99:923-7.
Brooks JA, Brunn DNS. Predictors of postoperative pulmonary complications following abdominal surgery. Chest 1997;111:564-71.
Ferreyra G, Long Y, Ranieri VM. Respiratory complications after major surgery. Current Opinion in Critical Care 2009;15:342–8.
Stéphan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 2000;118(5):1263-70.
Agostini P, Cieslik H, Rathinam S, Bishay E, Kalkat MS, Rajesh PB, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax 2010;65:815-8.
Eagle KA, Guyton RA, Davidiff R, Edwards FH, EwyGA, Fonger J, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article. J Am Coll Cardio, 2004; 44:1146-54.
Berry CB, Butler PJ, Myles PS. Lung management during cardiopulmonary bypass: is continuous positive airways pressure beneficial? Br J Anaesth 1993;71(6):864-8.
Dyhr T, Laursen N, Larsson A. Effects of lung recruitment maneuver and positive end-expiratory pressure on lung volume, respiratory mechanics and alveolar gas mixing in patients ventilated after cardiac surgery. Acta Anaesthesiol Scand. 2002;46(6):717-25.
Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE, Landreneau RJ, et al; ACOSOG Z0030 Study Group. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 2006;81:1013-20.
Garcia Miguel FJ, Serrano-Aguilar PG, Lopez-Bastida J. Preoperative assessment. Lancet 2003;362:1749–59.
Patel RL, Townsend ER, Fountain SW. Elective pneumonectomy: factors associated with morbidity and operative mortality. Ann Thorac Surg 1992; 54:84–8.
Renault JA, Costa-Val R, Rossetti MB. Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery. Rev Bras Cir Cardiovasc 2008;23:562-9.
Savci S, Sakin S, Inal Ince D, Arikan H, Can Z, Buran Y, Kuralay E. Active cycle of breathing techniques and incentive spirometer in coronary artery bypass graft surgery. Fizyoterapi Rehabilitasyon 2006;17:61-9.
Brooks D, Crowe J, Kelsey CJ, Lacy JB, Parsons J, Solway S. A clinical practice guideline on peri-operative cardiorespiratory physical therapy. Physiotherapy Canada 2001;53(1):9–25.
Tusman G, Bohm SH, Tempra A, Melkun F, Garcia E, Turchetto E, Mulder PG, Lachmann B: Effects of recruitment maneuver on atelectasis in anesthetized children. Anesthesiology 2003; 98:14–22
Berrizbeitia LD, Tessler S, Jacobowitz IJ,et al. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics: Comparison of internal mammary and saphenous vein bypass grafts. Chest 1989:96;873-6.
Kindgen-Milles D, Buhl R, Gabriel A, Böhner H and Müler. Nasal Continuous Positive Airway Pressure A Method to Avoid Endotracheal Reintubation in Postoperative High-risk Patients With Severe Nonhypercapnic Oxygenation Failure. Chest 2000;117:1106-11.
Ricksten SE, Bengtsson A, Soderberg C, Thorden M, Kvist H. Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Chest 1986;89: 774-81.
Overend T J, Anderson MA, Lucy SD, Bhatia C,Jonsson BI, Timmermans C. The Effect of Incentive Spirometry on Postoperative Pulmonary Complications.A Systematic Review. Chest 2001;120(3):971-8.
Gürses HN. Peroperatif rehabilitasyon, Kronik solunum yetersizliğinde solunum pompa desteği. Solunum 2002;4: 332-8.
Sarkıç S. Açık kalp ameliyatı geçiren hastalarda İnsentif Spirometre ile aktif solunum teknikleri döngüsünün etkinliğinin karşılaştırılması. Kardiyopulmoner Rehabilitasyon programı yüksek lisans tezi, Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü, Ankara, 2004.
Varela G, Ballesteros E, Jimenez MF, Novoa N, Aranda JL. Cost effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. Eur J Cardiothorac Surg 2006;29:216–20.
Braun SR, Brinbaum ML, ChoprA PS. Pre and postoperative pulmonary function abnormalities in coronary artery revascularization surgey. Chest 1978;73:316-20.