開腹手術前後の咳嗽時最大呼気流速の変化 [in Japanese] The Sequential Changes in Peak Cough Flow after Laparotomy [in Japanese]
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【目的】本研究の目的は開腹手術後の咳嗽時最大呼気流速(peak cough flow:PCF),肺活量(vital capacity:VC),創部痛の経時的変化とこれらの関係を明らかにすることである。【方法】待機的に開腹手術を行った30症例を対象にPCF,VC,安静時痛,咳嗽時痛を術前および術後13日目まで測定した。PCFはピークフローメーターを,VCはライトレスピロメーターを,疼痛はvisual analog scale (VAS)を用いて測定した。各項目間の関係はPearsonの相関分析を用いた。項目ごとの経時的変化の比較は一元配置分散分析を行い,多重比較はTamhane法を用いた。【結果】術後のPCFは術前値に対し術後1日目に46.4%まで低下し,術後5日目まで有意に低下していた。VCは術後1日目に47.8%まで低下し,術後6日目まで有意に低下した状態が続いた。術前PCFに対する回復率とVCの回復率,安静時・咳嗽時痛との間に有意な相関関係を認めた。またPCFとVCの間にも有意な相関が認められた。【結論】開腹手術患者に対しては,肺活量を上昇するような呼吸練習や痛みを軽減するための咳嗽介助など,周術期における理学療法士の積極的な関与の必要性が示唆された。
The purpose of this study was to investigate the sequential changes in peak cough flow (PCF), vital capacity (VC), and postoperative pain after laparotomy, and to determine the relationship among these measurements in patients undergoing laparotomy. Thirty patients undergoing elective surgery underwent measurement of PCF, VC, and postoperative pain at rest and during cough. These measurements were performed preoperatively and on postoperative days 1 to 9 and 13. PCF, VC, and postoperative pain were measured by peak flow meter, Wright respirometer, and visual analog scale (VAS), respectively. Correlations among these measurements were assessed using Pearson correlation coefficient. Sequential changes of these measurements were compared using a one-way ANOVA, and multiple comparisons were performed with Tamhane test. PCF was significantly depressed from day 1 through day 5, and VC was significantly reduced from day 1 through day 6 after surgery, compared with preoperative values. Recovery of VC and postoperative pain at rest and during cough were significantly correlated to recovery of PCF. Moreover, PCF and VC were significantly correlated. Our results help clarify sequential changes in PCF and the relationship between PCF, VC, and postoperative pain. These findings support the use of physical therapy techniques in perioperative patients, such as breathing exercises for increasing VC, and assisted cough for decreasing postoperative pain.
- Physical Therapy Japan
Physical Therapy Japan 35(7), 308-312, 2008
Japanese Society of Physical Therapy