吸气肌训练促进心脏机械瓣膜置换术后患者快速肺康复的研究进展

doi:10.3761/j.issn.2096-7446.2025.01.021

摘要/Abstract

摘要：

术后肺部并发症是造成心脏机械瓣膜置换术患者预后不良的主要原因之一，而吸气肌训练是促进患者术后快速肺康复关键技术之一。该文主要介绍了吸气肌训练的作用机制、吸气肌训练时机、实施方法以及训练后效果评价等，阐明吸气肌训练能够促进心脏机械瓣膜置换术后患者的肺康复，防止术后肺部并发症的发生，为其他心脏手术采取科学有效的吸气肌训练提供参考。

关键词: 心脏机械瓣膜置换术, 肺康复, 吸气肌训练, 肺部并发症, 综述文献（主题）

Abstract:

The occurrence of postoperative pulmonary complications is one of the main reasons for poor prognosis in patients undergoing mechanical heart valve replacement surgery. Inspiratory muscle training is one of the key technologies to promote postoperative rapid pulmonary rehabilitation in patients. This article mainly introduces the mechanism，timing and implementation methods of inspiratory muscle training，as well as the evaluation of effects after training. It explains that inspiratory muscle training can promote pulmonary rehabilitation in patients after mechanical heart valve replacement surgery，reduce the incidence of postoperative pulmonary complications，and provide reference for scientific and effective inspiratory muscle training in other cardiac surgeries.

Key words: Mechanical Heart Valve Replacement, Pulmonary Rehabilitation, Inspiratory Muscle Training, Pulmonary Complications, Review Literature as Topic

范咏诗, 冯雯娟, 马懿, 吴忠艳, 马文妮, 马子林, 黄英. 吸气肌训练促进心脏机械瓣膜置换术后患者快速肺康复的研究进展[J]. 中华急危重症护理杂志, 2025, 6(1): 124-128.

FAN Yongshi, FENG Wenjuan, MA Yi, WU Zhongyan, MA Wenni, MA Zilin, HUANG Ying. Research progress on inspiratory muscle training facilitating rapid pulmonary rehabilitation in patients after mechanical heart valve replacement[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(1): 124-128.

参考文献 25

[1]	陈小康, 张永恒. 心脏瓣膜置换术后患者生活质量的研究进展[J]. 华西医学, 2020, 35(8):1004-1011.
	Chen XK, Zhang YH. Research progress on the quality of life in patients after cardiac valve replacement[J]. West China Med J, 2020, 35(8):1004-1011.
[2]	Zhang HB, Li JZ, Liu Y, et al. Low-intensity international nor-malized ratio(INR) oral anticoagulant therapy in Chinese patients with mechanical heart valve prostheses[J]. Cell Biochem Biophys, 2012, 62(1):147-151. doi: 10.1007/s12013-011-9275-4 pmid: 21892782
[3]	张霞, 彭斯, 肖美慧, 等. 抗凝管理在机械瓣膜置换术后患者中的应用进展[J]. 中国护理管理, 2024, 24(1):157-160.
	Zhang X, Peng S, Xiao MH, et al. Research progress on anti-coagulation management in patients after mechanical heart valve replacement[J]. Chin Nurs Manag, 2024, 24(1):157-160.
[4]	唐攀力. 术前深呼吸训练器在心脏直视手术患者中的应用研究[D]. 大连: 大连医科大学, 2019.
	Tang PL. The application research of preoperative deep respi-ratory training apparatus in patients undergoing open heart surgery[D]. Dalian: Dalian Medical University, 2019.
[5]	Thybo Karanfil EO, Møller AM. Preoperative inspiratory muscle training prevents pulmonary complications after cardiac surgery - a systematic review[J]. Dan Med J, 2018, 65(3):A5450.
[6]	Cargnin C, Karsten M, Guaragna JCVDC, et al. Inspiratory mus-cle training after heart valve replacement surgery improves inspiratory muscle strength,lung function,and functional capa-city:a randomized controlled trial[J]. J Cardiopulm Rehabil Prev, 2019, 39(5):E1-E7.
[7]	王乾沙, 明玥, 谢玉生, 等. 吸气肌训练对慢性心力衰竭患者影响的系统评价再评价[J]. 中华护理杂志, 2023, 58(20):2521-2529. doi: 10.3761/j.issn.0254-1769.2023.20.013
	Wang QS, Ming Y, Xie YS, et al. Effect of inspiratory muscle training on clinical outcome of patients with chronic heart failure:an overview of systematic reviews[J]. Chin J Nurs, 2023, 58(20):2521-2529.
[8]	郭佳宝, 朱毅. 吸气肌训练的临床研究进展[J]. 中国康复医学杂志, 2014, 29(9):888-892.
	Guo JB, Zhu Y. Clinical research progress of inspiratory muscle training[J]. Chin J Rehabil Med, 2014, 29(9):888-892.
[9]	Ribeiro JP, Chiappa GR, Callegaro CC. The contribution of ins-piratory muscles function to exercise limitation in heart fai-lure:pathophysiological mechanisms[J]. Rev Bras Fisioter, 2012, 16(4):261-267.
[10]	Harada D, Asanoi H, Takagawa J, et al. Slow and deep res-piration suppresses steady-state sympathetic nerve activity in patients with chronic heart failure:from modeling to clinical application[J]. Am J Physiol Heart Circ Physiol, 2014, 307(8):H1159-H1168.
[11]	Troosters T, Blondeel A, Janssens W, et al. The past,present and future of pulmonary rehabilitation[J]. Respirology, 2019, 24(9):830-837. doi: 10.1111/resp.13517 pmid: 30868699
[12]	许志锋, 吴桂琴, 吴永前, 等. 术前呼吸肌训练对心脏瓣膜置换术吸气肌无力患者预后的影响[J]. 岭南心血管病杂志, 2023, 29(4):380-384.
	Xu ZF, Wu GQ, Wu YQ, et al. Effect of preoperative inspira-tory muscle training on postoperative recovery in inspiratory muscle weakness patients referred for cardiac valve replace-ment[J]. South China J Cardiovasc Dis, 2023, 29(4):380-384.
[13]	何文斌. 心脏瓣膜置换术后患者Ⅰ期心脏康复集束化护理策略的构建及效果评价[D]. 荆州: 长江大学, 2020.
	He WB. Construction and effect evaluation of bundles of care strategy of stage Ⅰ cardiac rehabilitation for patients after cardiac valve replacement[D]. Jingzhou: Yangtze University, 2020.
[14]	Hegazy FA, Mohamed Kamel SM, Abdelhamid AS, et al. Effect of postoperative high load long duration inspiratory muscle training on pulmonary function and functional capacity after mitral valve replacement surgery:a randomized controlled trial with follow-up[J]. PLoS One, 2021, 16(8):e0256609.
[15]	胡岳秀. 心脏瓣膜病患者围术期肺康复护理方案的构建与应用[D]. 南京: 南京中医药大学, 2022.
	Hu YX. Construction and application of perioperative pulmo-nary rehabilitation nursing program in patients with valvular heart disease[D]. Nanjing: Nanjing University of Chinese Medi-cine, 2022.
[16]	Crisafulli E, Costi S, Fabbri LM, et al. Respiratory muscles training in COPD patients[J]. Int J Chron Obstruct Pulmon Dis, 2007, 2(1):19-25. doi: 10.2147/copd.2007.2.1.19 pmid: 18044062
[17]	罗泽汝心, 王渝强, 周亚馨, 等. 术前吸气肌训练预防成人心脏手术患者术后肺部并发症的最新进展[J]. 中国胸心血管外科临床杂志, 2023, 30(10):1519-1523.
	Luo ZRX, Wang YQ, Zhou YX, et al. Research progress on preoperative inspiratory muscle training for prevention of postoperative pulmonary complications in adult cardiac surgery[J]. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(10):1519-1523.
[18]	Dos Santos TD, Pereira SN, Portela LOC, et al. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery:a randomized clinical trial[J]. Int J Cardiol, 2019,279:40-46.
[19]	Matheus GB, Dragosavac D, Trevisan P, et al. Inspiratory mus-cle training improves tidal volume and vital capacity after CABG surgery[J]. Rev Bras Cir Cardiovasc, 2012, 27(3):362-369.
[20]	Kodric M, Trevisan R, Torregiani C, et al. Inspiratory muscle training for diaphragm dysfunction after cardiac surgery[J]. J Thorac Cardiovasc Surg, 2013, 145(3):819-823. doi: 10.1016/j.jtcvs.2012.07.087 pmid: 22938776
[21]	Ramirez-Sarmiento A, Orozco-Levi M, Guell R, et al. Inspira-tory muscle training in patients with chronic obstructive pul-monary disease:structural adaptation and physiologic out-comes[J]. Am J Respir Crit Care Med, 2002, 166(11):1491-1497.
[22]	Zhou HF, Liu FY, Liu YH, et al. Protocol for the PORT study:short-term perioperative rehabilitation to improve outcomes in cardiac valvular surgery - a randomised control trial[J]. BMJ Open, 2023, 13(12):e074837.
[23]	武亮, 董继革, 郭琪, 等. 中国社区心肺康复治疗技术专家共识[J]. 中国老年保健医学, 2018, 16(3):41-51,56.
	Wu L, Dong JG, Guo Q, et al. Expert consensus on cardiopul-monary rehabilitation in China community[J]. Chin J Geriatr Care, 2018, 16(3):41-51,56.
[24]	张文文, 张喜维, 何明伟, 等. 综合疼痛管理在心脏外科围手术期康复中应用效果的回顾性比较[J]. 心肺血管病杂志, 2023, 42(11):1143-1148.
	Zhang WW, Zhang XW, He MW, et al. Application of com-prehensive pain care in perioperative care of cardiac surgery[J]. J Cardiovasc Pulm Dis, 2023, 42(11):1143-1148.
[25]	van Buuren S, Hulzebos EHJ, Valkenet K, et al. Reference chart of inspiratory muscle strength:a new tool to monitor the effect of pre-operative training[J]. Physiotherapy, 2014, 100(2):128-133. doi: 10.1016/j.physio.2013.08.007 pmid: 24216046