哮喘联盟

   摘要
   背景：咳嗽损害通常被描述为术后肺部并发症（PPCs）的病理生理基础的一部分。然而，很少有研究探讨止咳效果及其与开放上腹部手术后肺部并发症的关系。此项研究旨在通过上腹部手术后来评估（1）咳嗽效果的变化，主要通过对峰咳嗽流量和（2）咳嗽损害与术后疼痛、用力呼气容积（FVC）和术后肺部并发症（PPCs）之间的风险关联程度。
   方法：该前瞻性队列研究评估101例入院择期进行上腹部手术的患者（45％为男性，56±16岁）。手术前一天进行咳嗽流动峰值和FVC测量，并在术后1、3和5天对上述指标进行重复测量。由肺病专家每日对PPCs进行评估，这些专家对咳嗽测量结果是不知晓的。
   结果：术后第1天咳嗽流量峰值下降到术前值的54％，并在术后第3和第5天逐渐增加到（65％）和（72％）（P <0.05）。术后所有天数中，咳嗽高峰流量与FVC密切相关（P <0.001），与疼痛呈弱相关（P =0.006）。6例（6％）患者出现术后并发症（PPCs），咳嗽峰值流量与PPCs风险之间的关联无统计学显著（未经调整的比值比为0.80，95％CI为0.45-1.40，P=0.44;调整后的比值比为0.66，95％C为I0.32-1.38，P =0.41 ）。
   结论：上腹部手术后咳嗽的有效性受损。术后限制性肺功能障碍似乎与此缺陷相关。咳嗽峰值流动和PPCs之间无显著关联；然而，咳嗽损害可能导致临床中高危人群产生严重后果。

 

（苏欣 审校）
Respir Care. 2015 Feb 10. pii: respcare.03600. [Epub ahead of print]


 

Cough Impairment and Risk of Postoperative Pulmonary Complications After Open Upper Abdominal Surgery.
 

Bonfim Colucci DB1, Fiore JF Jr2, Paisani DM3, Risso TT4, Colucci M5, Chiavegato LD6, Faresin SM7.

ABSTRACT
BACKGROUND: Cough impairment is often described as part of the pathophysiological basis of postoperative pulmonary complications (PPCs). However, there have been few studies examining cough effectiveness and its relationship with PPCs following open upper abdominal surgery. The goal of this study was to estimate (1) changes in cough efficacy after upper abdominal surgery through the assessment of peak cough flow and (2) the extent to which cough impairment is associated with postoperative pain, FVC, and risk of PPCs.
METHODS: This prospective cohort study assessed 101 subjects (45% male, 56 ± 16 y old) admitted for elective upper abdominal surgery. Measurements of peak cough flow and FVC were performed on the day before surgery and repeated on postoperative days 1, 3, and 5. PPCs were assessed daily by a pulmonologist blinded to the cough measurement results.
RESULTS: Peak cough flow dropped to 54% of the preoperative value on postoperative day 1 and gradually increased on postoperative days 3 (65%) and 5 (72%) (P < .05). On all postoperative days, peak cough flow was strongly correlated with FVC (P < .001) and weakly correlated with pain (P = .006). Six subjects (6%) developed PPCs. The association between peak cough flow and risk of PPCs was not statistically significant (unadjusted odds ratio of 0.80, 95% CI 0.45-1.40, P = .44; adjusted odds ratio of 0.66, 95% CI 0.32-1.38, P = .41).
CONCLUSIONS: Cough effectiveness is impaired after upper abdominal surgery. Postoperative restrictive lung dysfunction seems to be associated with this impairment. There is no significant association between peak cough flow and PPCs; however, cough impairment might result in clinically important consequences in a high-risk population.

Respir Care. 2015 Feb 10. pii: respcare.03600. [Epub ahead of print]