引用文本：罗薇, 王璇, 卢晓淋, 等. 拔管后即刻呼吸锻炼对上腹部开放手术术后肺不张的影响[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(4): 524-531.

作者：罗薇1, 王璇2, 卢晓淋2, 肖颖2, 陈晓翔2

单位：1. 四川大学华西口腔医院麻醉科，四川　成都　610041；2. 中山大学附属第一医院麻醉科，广东　广州　510080

Authors：Luo Wei1, Wang Xuan2, Lu Xiaolin2, Xiao Ying2, Chen Xiaoxiang2

Unit：1. Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China；2. Department of Anesthesiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

目的 探讨在行上腹部开放手术的术后肺部并发症（postoperative pulmonary complications, PPCs）中高风险患者中，拔管后即刻进行呼吸锻炼对术后肺不张的影响。方法 本项单中心、前瞻性、评估者单盲的随机对照研究选取2021年5月至2022年5月于中山大学附属第一医院限期行上腹部开放手术的PPCs中高风险患者176例，采用随机数字表按1∶1分成非呼吸锻炼组（n=89）和呼吸锻炼组（n=87）。非呼吸锻炼组的患者仅接受常规围手术期诊疗，未进行专门的呼吸锻炼。呼吸锻炼组的患者在术前接受呼吸锻炼宣教，并于拔管后即刻及30 min后在研究者指导和督促下进行呼吸锻炼。主要结局指标为术后3 d内的肺部超声评分（lung ultrasound score, LUS），次要结局指标包括拔管后1 h氧合指数（oxygenation index, OI）与术前OI的差值（∆OI）、术后住院时长、出院后30 d再住院情况等。结果 因随访中有25例患者失访，最终纳入151例患者进行分析（非呼吸锻炼组75例，呼吸锻炼组76例）。与非呼吸锻炼组相比，呼吸锻炼组拔管后1 h及术后前3 d的LUS更低（均P＜0.05）。两组患者术后OI均较术前降低，呼吸锻炼组拔管后1 h的OI高于非呼吸锻炼组（P=0.002），且∆OI较非呼吸锻炼组降低幅度更小（P＜0.001）。两组其余次要结局指标（如术后住院时长、出院后30 d再住院率等）差异均无统计学意义（均P＞0.05）。结论 拔管后即刻呼吸锻炼作为一种简单易行的干预措施，在行限期上腹部开放手术的PPCs中高风险患者中，可以有效预防肺不张，改善术后肺通气和氧合情况。

关键词：呼吸锻炼；术后肺不张；上腹部手术；肺部超声

Abstract：

Objective To evaluate the effect of immediate post-extubation breathing exercises on postoperative pulmonary atelectasis in patients undergoing elective upper abdominal open surgery with moderate to high risk of postoperative pulmonary complications (PPCs). Method In this single-center, prospective, assessor-blinded randomized controlled trial, 176 patients with moderate to high risk of PPCs undergoing elective upper abdominal open surgery at the First Affiliated Hospital of Sun Yat-sen University from May 2021 to May 2022 were enrolled and assigned to either a breathing exercise group (n=87) or a control group (no breathing exercise, n=89) by random number table at a 1∶1 ratio. Patients in the control group received only routine perioperative care and did not undergo any specific breathing exercises. Patients in the breathing exercise group received preoperative education on breathing exercises and were instructed and encouraged by the researchers to perform breathing exercises immediately after extubation and 30 minutes later. The primary outcome was the lung ultrasound score (LUS) within 3 days after surgery. Secondary outcomes included changes in oxygenation index (OI) (∆ OI = postoperative OI﹣preoperative OI), postoperative length of hospital stay, and readmission rate within 30 days after discharge, etc.　Result After accounting for 25 cases of follow-up losses, 151 patients were included in the final analysis (control group, n=75; breathing exercise group, n=76). Compared with the control group, the breathing exercise group had a significantly lower LUS at 1 hour post-extubation and 3 consecutive days after surgery (all P<0.05). Although both groups showed a postoperative decline in OI, patients in the breathing exercise group had a higher OI at 1 hour post-extubation (P=0.002) and a smaller ∆OI reduction (P<0.001). There were no statistically significant differences between the groups in other secondary outcomes (such as postoperative length of stay and 30-day readmission rate) (all P>0.05). Conclusion Immediate breathing exercises after extubation is a simple and feasible intervention that can effectively prevent pulmonary atelectasis and improve postoperative pulmonary ventilation function and oxygenation in moderate to high risk patients undergoing elective upper abdominal open surgery.

Key words：Breathing exercises; Postoperative pulmonary atelectasis; Upper abdominal surgery; Lung ultrasonography

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