高频胸壁振荡在高龄患者心脏外科手术后的应用

摘要

目的 探讨高频胸壁振荡(HFCWO)在高龄患者心脏外科手术后应用的耐受性、安全性和临床效果.方法 201例接受心脏外科手术的高龄患者(＞70岁)于拔除气管插管6～8h后行HFCWO联合人工胸部物理治疗(HFCWO组),应用Likert量表对每次治疗的耐受性进行评估,并观察患者初次HFCWO治疗前10 min、治疗中和治疗结束后10 min的循环和呼吸指标(心率、收缩压、中心静脉压、肺动脉平均压、呼吸频率和脉搏血氧饱和度)的变化.以仅行人工胸部物理治疗的165例心脏外科手术高龄患者(＞70岁)作为对照组,比较两组患者的临床资料(术后肺部感染发生率、胸腔积液发生率、肺不张发生率、二次气管插管率、ICU滞留时间、抗生素使用时间和住院时间).结果 HFCWO组共行984次HFCWO治疗,其中813次(82.62％)能够被患者较好耐受,66次(6.71％)不能耐受；未发生与HFCWO相关的不良事件；患者初次HFCWO治疗前10 min、治疗中和治疗结束后10 min的心率、收缩压、中心静脉压、肺动脉平均压、呼吸频率和脉搏血氧饱和度均无显著变化(P＞0.05).HFCWO组术后肺部感染发生率和胸腔积液发生率均显著低于对照组(3.98％ vs 9.09％,P＜0.05；6.47％ vs 12.72％,P＜0.05),术后抗生素使用时间和住院时间也显著短于对照组[(5.07±2.23)d vs (6.98±2.41)d,P＜0.05；(9.58±4.10)d vs (11.79±5.06)d,P＜0.05],而两组术后肺不张发生率、二次气管插管率和ICU滞留时间差异无统计学意义(P＞0.05).结论 HFCWO在高龄患者心脏外科手术后拔除气管插管后早期应用安全,且能被大多数患者很好耐受.HFCWO联合人工胸部物理治疗对减少术后肺部感染、胸腔积液和抗生素的使用有一定作用.%Objective To evaluate the tolerability, safety and efficacy of high-frequency chest wall oscillation ( HFCWO) in elderly patients after cardiac surgery. Methods Two hundred and one consecutive patients aged more than 70 undergoing cardiac surgery received HFCWO combined with manual chest physiotherapy 6 to 8 h after extubation ( HFCWO group). The tolerability of patients to HFCWO therapy was assessed with Likert scale, and the changes of circulatory and respiratory parameters of heart rate, systolic blood pressure, central venous pressure, mean pulmonary arterial pressure, breathing rate and pulse oxygen saturation were measured 10 min before, during and 10 min after initial HFCWO therapy. Besides, another 165 consecutive patients aged more than 70 undergoing cardiac surgery treated only with manual chest physiotherapy were served as controls, and the related clinical parameters of incidences of postoperative pneumonia, pleural effusion, atelectasis, re-endotracheal intubation, durations of ICU slay and antibiotics use and length of stay were compared between two groups. Results A total of 984 therapies of HFCWO were performed, of which 813 (82.62%) were well tolerated, while 66 (6. 71% ) were hardly tolerated. No HFCWO therapy-related adverse events were reported. There was no significant change in heart rate, systolic blood pressure, central venous pressure, mean pulmonary arterial pressure, breathing rate and pulse oxygen saturation 10 min before, during and 10 min after initial HFCWO therapy (P >0. 05). The incidences of postoperative pneumonia and pleural effusion in HFCWO group were significantly lower than those in control group (3. 98% vs 9. 09% , P < 0. 05; 6. 47% vs 12. 72% , P < 0. 05), and ihe duration of postoperative antibiotics use and length of stay in HFCWO group were significantly shorter than those in control group [ (5. 07 ± 2. 23) d vs (6. 98 ± 2. 41) d, P<0. 05; (9. 58 ±4. 10) dm (11. 79 ±5. 06) d, P <0. 05], while there was no significant difference in the incidences of postoperative atelectasis and re-endotracheal intubation and duration of postoperative ICU stay between two groups (P > 0. 05). Conclusion HFCWO is a safe and well-tolerated adjunct after extubalion following cardiac surgery in elderly patients. Combined with manual chest physiotherapy, HFCWO may help to reduce postoperative pneumonia, pleural effusion and use of antibiotics.