ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 >

2023 , Vol. 4 >Issue 6: 485 - 492

DOI: https://doi.org/10.3761/j.issn.2096-7446.2023.06.001

论著

重度脊柱侧凸患者围手术期肺康复方案的构建及应用研究

  • 马姚静 ,
  • 余群飞 ,
  • 王鑫鑫 ,
  • 任英 ,
  • 许国萍 ,
  • 袁喆
展开
  • 310009 杭州市 浙江大学医学院附属第二医院骨科（马姚静,余群飞,王鑫鑫,许国萍,袁喆）,护理教育部（任英）
马姚静：女,本科（硕士在读）,主管护师,护士长,E-mail：2504029@zju.edu.cn

收稿日期: 2023-03-02

  网络出版日期: 2023-06-01

基金资助

浙江省医药卫生科技计划（2023KY764）;浙江省医药卫生科技计划（2023KY738）;浙江省医药卫生科技计划（2019KY403）

收起

Construction and application of perioperative pulmonary rehabilitation program in patients with severe scoliosis

  • MA Yaojing ,
  • YU Qunfei ,
  • WANG Xinxin ,
  • REN Ying ,
  • XU Guoping ,
  • YUAN Zhe
Expand
  • Department of Orthopaedics,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou, 310009,China

Received date: 2023-03-02

  Online published: 2023-06-01

Fold

摘要

目的 构建重度脊柱侧凸患者围手术期肺康复方案,并探讨其临床应用效果。方法 运用文献分析法和专家咨询构建重度脊柱侧凸患者围手术期肺康复方案。采用方便抽样法,选择杭州市某三级甲等医院骨科2021年7月—2022年10月收治的28例重度脊柱侧凸患者作为试验组,2020年1月—2021年6月收治的30例重度脊柱侧凸患者作为对照组。试验组在常规护理基础上采用重度脊柱侧凸患者围手术期肺康复方案,对照组采用常规护理,比较两组肺通气功能、六分钟步行试验距离、肺部并发症、肺康复不良事件发生率的差异。结果 术后1周、术后1月,试验组的第1秒用力呼气容积占预计值百分比、用力肺活量占预计值百分比、肺活量占预计值百分比、六分钟步行试验距离均高于对照组,差异均具有统计学意义（P<0.05）。术后1周,两组肺部并发症发生率比较,差异具有统计学意义（χ2=40.069,P<0.001）;术后1月,两组均无肺部并发症发生。两组在肺康复中均未发生跌倒、急性运动损伤、心血管不良事件等。结论 重度脊柱侧凸患者围手术期肺康复方案有利于提高患者术后肺通气功能及短期活动能力,降低肺部并发症发生率。未来可进一步延长随访时间,明确重度脊柱侧凸围手术期肺康复方案在术后患者的肺功能变化的长期效果。

关键词： 脊柱侧凸; 肺康复; 呼吸锻炼; 肺通气; 围手术期护理

本文引用格式

马姚静 , 余群飞 , 王鑫鑫 , 任英 , 许国萍 , 袁喆 . 重度脊柱侧凸患者围手术期肺康复方案的构建及应用研究[J]. 中华急危重症护理杂志, 2023 , 4(6) : 485 -492 . DOI: 10.3761/j.issn.2096-7446.2023.06.001

Abstract

Objective To establish a pulmonary rehabilitation program for patients with severe scoliosis during perioperative period,and to discuss its clinical effect. Methods Literature analysis and expert consultation were used to construct the perioperative pulmonary rehabilitation program for patients with severe scoliosis. A total of 28 patients with severe scoliosis admitted from July 2021 to October 2022 to a tertiary Grade-A hospital in Hangzhou were selected as the experimental group and 30 patients with severe scoliosis admitted from January 2020 to June 2021 as the control group by convenient sampling method. The experimental group received perioperative pulmonary rehabilitation program for patients with severe scoliosis on the basis of routine nursing,and the control group received routine nursing. The differences of pulmonary ventilation function,6-minute walking test distance,and incidence of pulmonary complications between the two groups were compared. Results One week after surgery and one month after surgery,the percentage of forced expiratory volume in onet second of the predicted value,the percentage of forced vital capacity in the predicted value,the percentage of vital capacity in the predicted value and the 6-minute walking distance of the experimental group were higher than those of the control group,the differences were statistically significant（P<0.05）. One week after surgery,the incidence of pulmonary complications was statistically different between the two groups（χ2=40.069,P<0.001）. One month after surgery,no pulmonary complications occurred in both groups. No fall,acute motor injury or cardiovascular adverse events occurred in the two groups during pulmonary rehabilitation. Conclusion Perioperative pulmonary rehabilitation is beneficial to improve postoperative pulmonary ventilation function and short-term activity ability in patients with severe scoliosis,and reduce the incidence of pulmonary complications. In the future,follow-up time can be further extended to determine the long-term effect of perioperative pulmonary rehabilitation program on postoperative lung function changes in patients with severe scoliosis.

Key words： Scoliosis; Pulmonary Rehabilitation; Breathing Exercises; Pulmonary Ventilation; Perioperative Nursing

参考文献

[1] 胡嫒,陈唯韫,马璐璐. 综合征性脊柱侧凸矫形手术的围手术期管理[J]. 中华骨与关节外科杂志,2022,15(11):845-849.
Hu A,Chen WY,Ma LL.Perioperative manage of corrective surgery for syndromic scoliosis[J]. Chin J Bone Jt Surg,2022, 15(11):845-849.
[2] Roberts JM.Scoliosis:the clinical overview[J]. RN,1976,39(11):57-58.
[3] Seleviciene V,Cesnaviciute A,Strukcinskiene B,et al.Physiotherapeutic scoliosis-specific exercise methodologies used for conservative treatment of adolescent idiopathic scoliosis,and their effectiveness:an extended literature review of current research and practice[J]. Int J Environ Res Public Health,2022, 19(15):9240.
[4] 谭焜月,刘春霞,黄晓凤,等. 先天性脊柱侧凸与特发性脊柱侧凸伴发心脏异常对比:438例回顾性分析[J]. 中华骨与关节外科杂志,2022,15(5):367-372.
Tan KY,Liu CX,Huang XF,et al.Comparison of congenital scoliosis and idiopathic scoliosis with cardiac abnormalities:a retrospective study of 438 patients[J]. Chin J Bone Joint Surg,2022,15(5):367-372.
[5] Shakil H,Iqbal ZA,Al-Ghadir AH.Scoliosis:review of types of curves,etiological theories and conservative treatment[J]. J Back Musculoskelet Rehabil,2014,27(2):111-115.
[6] Troosters T,Blondeel A,Janssens W,et al.The past,present and future of pulmonary rehabilitation[J]. Respirology,2019,24(9):830-837.
[7] Veldhoen ES,de Vries A,Schlosser TPC,et al. Short-term effect and effect on rate of lung function decline after surgery for neuromuscular or syndromic scoliosis[J]. Pediatr Pulmonol,2022,57(5):1303-1309.
[8] 刘西花,伊长松,周铂,等. 特发性脊柱侧凸青少年患者肺功能的影响因素分析[J]. 中华物理医学与康复杂志,2022,44(8):732-735.
Liu XH,Yi CS,Zhou B,et al.Factors influencing pulmonary function in persons with adolescent idiopathic scoliosis[J]. Chin J Phys Med Rehabil,2022,44(8):732-735.
[9] Qi KX,Fu HD,Yang Z,et al.Effects of core stabilization training on the Cobb angle and pulmonary function in adolescent patients with idiopathic scoliosis[J]. J Environ Public Health,2022,2022:1-6.
[10] 宫玉翠,陈洁雅,李平东,等. 慢性呼吸疾病肺康复护理专家共识[J]. 中华护理杂志,2020,55(5):709-710.
Gong YC,Chen JY,Li PD,et al.Expert consensus on pulmonary rehabilitation nursing of chronic respiratory diseases[J]. Chin J Nurs,2020,55(5):709-710.
[11] Alison JA,McKeough ZJ,Johnston K,et al. Australian and New Zealand pulmonary rehabilitation guidelines[J]. Respirol Carlton Vic,2017,22(4):800-819.
[12] Rugbjerg M,Iepsen UW,Jørgensen KJ,et al.Effectiveness of pulmonary rehabilitation in COPD with mild symptoms:a systematic review with meta-analyses[J]. Int J Chron Obstruct Pulmon Dis,2015,10:791-801.
[13] 武亮,郭琪,胡菱,等. 中国呼吸重症康复治疗技术专家共识[J]. 中国老年保健医学,2018,16(5):3-11.
Wu L,Guo Q,Hu L,et al.Expert consensus on respiratory intensive care rehabilitation technology in China[J]. Chin J Geriatric Care,2018,16(5):3-11.
[14] Li Q,Zeng F,Chen T,et al.Management of severe scoliosis with pulmonary arterial hypertension:a single-center retrospective case series study[J]. Geriatr Orthop Surg Rehabil,2022,13:215145932210802.
[15] Sucato DJ.Management of severe spinal deformity[J]. Spine,2010,35(25):2186-2192.
[16] Chen J,Sui WY,Yang JF,et al.The radiographic,pulmonary,and clinical outcomes of patients with severe rigid spinal deformities treated via halo-pelvic traction[J]. BMC Musculoskelet Disord,2021,22(1):1-8.
[17] 于洋,姚媛媛,明月,等. 脊柱侧弯矫形手术患者术后肺部并发症的危险因素[J]. 临床麻醉学杂志,2022,38(10):1071-1075.
Yu Y,Yao YY,Ming Y,et al.Risk factors of postoperative pulmonary complications in patients undergoing scoliosis fusion surgery[J]. J Clin Anesthesiol,2022,38(10):1071-1075.
[18] 霍良红,胡璟,张建敏. 肺保护性通气策略对脊柱侧弯矫形术患儿术后肺部并发症的影响:基于倾向性评分匹配的回顾性队列研究[J]. 中华麻醉学杂志,2020(6):646-650.
Huo LH,Hu J,Zhang JM.Effect of lung-protective ventilation strategy on postoperative pulmonary complications in pediatric patients undergoing scoliosis surgery:a retrospective propensity score-matched cohort study[J]. Chin J Anesthesiol,2020(6):646-650.
[19] 冯芳,胡西贝,韩明明,等. 目标导向液体治疗对脊柱侧弯矫形手术患者术中局部脑氧饱和度和术后并发症的影响[J]. 临床麻醉学杂志,2019,35(4):319-322.
Feng F,Hu XB,Han MM,et al.Effects of goal-directed fluid therapy on intraoperative regional cerebral oxygen and postoperative complications in patients undergoing spinal scoliosis surgery[J]. J Clin Anesthesiol,2019,35(4):319-322.
[20] 中国康复医学会循证康复医学工作委员会,中国康复研究中心/中国康复科学所康复信息研究所,兰州大学循证医学中心,等. 慢性阻塞性肺疾病临床康复循证实践指南[J]. 中国康复理论与实践,2021,27(1):15-26.
Evidence-based Rehabilitation Medicine Working Committee of Chinese Rehabilitation Medicine Association,Rehabilitation Information Research Institute of China Rehabilitation Research Center/China Rehabilitation Sciences Institute,Evidence-based Medicine Center of Lanzhou University,et al. Evidence-based practice guide for clinical rehabilitation of chronic obstructive pulmonary disease[J]. Chin J Rehabil Theory Pract,2021,27(1):15-26.
[21] 刘绍,王丽雯,王素梅,等. 肺康复在机械通气患者中应用效果的Meta分析[J]. 中华急危重症护理杂志,2021,2(2):140-145.
Liu S,Wang LW,Wang SM,et al.Pulmonary rehabilitation in patients with mechanical ventilation:a Meta-analysis[J]. Chin J Emerg Crit Care Nurs,2021,2(2):140-145.
[22] 贺轲渝,王惟,程鹏,等. 全身麻醉术后肺部并发症发生的影响因素分析[J]. 实用医院临床杂志,2022,19(5):62-65.
He KY,Wang W,Cheng P,et al.Analysis of influencing factors of pulmonary complications after general anesthesia[J]. Pract J Clin Med,2022,19(5):62-65.
[23] Yuan NC,Fraire JA,Margetis MM,et al.The effect of scoliosis surgery on lung function in the immediate postoperative period[J]. Spine,2005,30(19):2182-2185.
[24] Lin YX,Feng EW,Shen JX,et al.Influences of thoracic spinal deformity on exercise performance and pulmonary function:a prospective study of 168 patients with adolescent idiopathic scoliosis[J]. Spine(Phila Pa 1976),2022,47(3):E107-E115.
[25] Sun Y,Zhang Y,Ma HN,et al.Halo-pelvic traction in the treatment of severe scoliosis:a meta-analysis[J]. Eur Spine J,2023,32(3):874-882.
[26] Zhou X,Zhang Z,Yang Y,et al.Pulmonary recovery following corrective surgery in adult patients with severe scoliosis:a minimum of five-year follow-up[J]. Front Med,2022,9:915904.
[27] Smith SMS,Chaudhary K,Blackstock F.Concordant evidence-based interventions in cardiac and pulmonary rehabilitation guidelines[J]. J Cardiopulm Rehabil Prev,2019,39(1):9-18.
[28] 朱为模. 《ACSM运动测试与运动处方指南》的过去、现在与未来[J]. 体育科研,2022,43(6):1-9,46
Zhu WM.The past,present and future of ACSM's guidelines for exercise testing and prescrition[J]. Sports Sci Res,2022, 43(6):1-9,46.
[29] 王华东,尹欣,杨亚锋,等. 退变性脊柱侧凸长节段固定矫形融合术后冠状面失平衡相关危险因素分析[J]. 中国脊柱脊髓杂志,2021,31(11):992-998.
Wang HD,Yin X,Yang YF,et al.Analysis of the risk factors related to coronal plane imbalance after correction of degenerative scoliosis[J]. Chin J Spine Spinal Cord,2021,31(11):992-998.
Options
文章导航

/

〈 〉