Koroner arter bypass greft cerrahisinde aktif solunum teknikleri döngüsü ve insentif spirometre

Amaç: Bu çalışmada koroner arter bypass greft (KABG) cerrahisinden sonra insentif spirometre (İS) ve aktif solunum teknikleri döngüsünün (ASTD) etkinliğinin değerlendirilmesi amaçlandı. Gereç ve yöntem: Bu prospektif randomize çalışmaya 60 erkek hasta alındı. Mobilizasyonla kombine olarak 30 hastaya ASTD ve 30 hastaya İS uygulandı. Hastalar solunum fonksiyon testleri, arteryel kan gazları, 6 dakikalık yürüme testi (6DYT), göğüs radyografi ve ağrı algılaması için 10 cm’lik görsel analog skalası ile değerlendirildi. Sonuçlar: Postoperatif beşinci günde her iki grupta da solunum fonksiyonları preoperatif değerlerle karşılaştırıldığında anlamlı olarak azaldı (vital kapasite ASTD’de % 15, İS’de % 18 azaldı, p0.05). Tartışma: Her iki tedavi de postoperatif birinci günden itibaren arteryel oksijenasyonu artırdı. Beş günlük tedaviden sonra, ASTD veya İS’nin kullanımı ile fonksiyonel kapasite iyi bir şekilde korundu. Her iki fizyoterapi yöntemi atelektazi insidansı, pulmoner fonksiyon ve ağrı algılamasını benzer şekilde etkiledi

Active cycle of breathing techniques and incentive spirometer in coronary artery bypass graft surgery

Keywords:

-,

___

  • Richter Larsen K, Ingwersen U, Thode S, et al. Mask physiotherapy in patients after heart surgery: a controlled study. Intensive Care Med. 1995;21:469-474.
  • Crowe JM, Bradley CA. The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Phys Ther. 1997;77:260-268.
  • Stiller K, Montarello J, Wallace M, et al. Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Chest. 1994;105:741-747.
  • O’Donohue WJ Jr. National survey of the usage of lung expansion modalities for the prevention and treatment of postoperative atelectasis following abdominal and thoracic surgery. Chest. 1985;87:76-80.
  • Wattie J. Incentive spirometry following coronary artery bypass surgery. Physiotherapy. 1998;84:508-514.
  • Kunduracılar Z. Koroner arter cerrahisinde postoperatif erken dönemde uygulanan göğüs fizyoterapisi yöntemlerinin karşılaştırılması. Fizik Tedavi ve Rehabilitasyon Programı Doktora Tezi. Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü. Ankara; 1998.
  • Oulton JL, Hobbs GM, Hicken P. Incentive breathing devices and chest physiopathy: a controlled therapy. Can J Surg. 1981;24:638-640.
  • Pryor JA, Webber BA. Physiotherapy techniques. In: Pryor JA, Prasad SA, eds. Physiotherapy for Respiration and Cardiac Problems: Adults and Pediatrics. 3rd ed. Edinburgh: Churchill Livingstone; 2002:161-241.
  • Webber BA, Hofmeyr JL, Morgan MD, et al. Effects of postural drainage, incorporating the forced expiration technique, on pulmonary function in cystic fibrosis. Br J Dis Chest. 1986;80:353-359.
  • Savci S, Inal-Ince D, Arikan H. A comparison of autogenic drainage and the active cycle of breathing techniques in patients with chronic obstructive pulmonary diseases. J Cardiopulm Rehabil. 2000;20:37- 43.
  • Inal-Ince D, Savci S, Topeli A, et al. Active cycle of breathing techniques in noninvasive ventilation for acute hypercapnic respiratory failure. Aust J Physiother. 2004;50:67-73.
  • Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-829.
  • Quanjer PH, Tammeling GJ, Cotes JE, et al. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993;16:5-40.
  • ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111- 117.
  • Enright PL, Sherill DL. Reference equations for the six- minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384-1387.
  • Westerdahl E, Lindmark B, Almgren SO, et al. Chest physiotherapy after coronary artery bypass graft surgery–a comparison of three different deep breathing techniques. J Rehabil Med. 2001;33:79-84.
  • Deloach LJ, Higgins MS, Caplan AB, et al. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anaesth Analg. 1998;86:102-106.
  • Green SB, Salkind NJ, Akey TM. Using SPSS for Windows: Analyzing and Understanding Data. 2nd ed. New Jersey: Prentice Hall; 2000.
  • Westerdahl E, Lindmark B, Eriksson T, et al. The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scand Cardiovasc J. 2003;37:363-367.
  • Blaney F, Sawyer T. Sonographic measurement of diaphragmatic motion after upper abdominal surgery: a comparison of three breathing manoeuvres. Physiother Theory Pract. 1997;13:207-215.
  • Menkes HA, Traystman RJ. Collateral ventilation. Am Rev Respir Dis. 1977;116:287-309.
  • Ward RJ, Danziger F, Bonica JJ, et al. An evaluation of post-operative respiratory manoeuvres. Surg Gynecol Obstet. 1966;123:51-54.
  • Pasquina P, Tramer MR Walder B. Prophylactic respiratory physiotherapy after cardiac surgery: systematic review. BMJ. 2003;327:1379-1381.
  • Locke TJ, Griffiths TL, Mould H, et al. Rib cage mechanics after median sternotomy. Thorax. 1990;45:465-468.
  • Cockram J, Jenkins SK, Clugston R. Cardiovascular and respiratory responses to early ambulation and stair climbing following coronary artery surgery. Physiother Theory Pract. 1999;15:3-15.
  • Wasserman K, Whipp BJ. Exercise physiology in health and disease. Am Rev Respir Dis. 1975;112:219-249.
  • Arthur HM, Daniels C, McKelvie R, et al. Effect of a preoperative intervention on preoperative and postoperative outcomes in low risk patients awaiting elective coronary artery bypass graft surgery: a randomised controlled trial. Ann Intern Med. 2000;133:253-262.
  • Opasich C, De Feo S, Pinna GD, et al. Distance walked in the 6-minute test soon after cardiac surgery: toward an efficient use in the individual patient Chest. 2004;126:1796-1801.
  • Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J. 1999;14:270-274.