硬膜外持続鎮痛施行患者における術後早期呼吸訓練の効果
硬膜外持続鎮痛法を用いた上腹部術後患者26名を,術後3日間深呼吸だけを1日10回行なった群(DB群),トリフローIITMを1日5回行なった1群(TF I群)および1日10回行なった群(TF II群)の3群に分け,incentive spirometerを用いた術後早期の呼吸訓練が,術後の呼吸機能改善に有効かどうかを検討した.鎮痛効果は3群間に差はなく,深呼吸でも痛みを訴えない程度に維持された.呼吸機能について,肺活量,1秒率,最大呼気流速は,それぞれ3群間に有意差はなく,術後1日に術前値の50%に低下し,その後回復し術後10日で術前値の80%程度となった.PaO2は術前値に比べ術後3日間は低い...
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Published in | 日本臨床麻酔学会誌 Vol. 15; no. 10; pp. 678 - 684 |
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Main Authors | , , , , |
Format | Journal Article |
Language | Japanese |
Published |
日本臨床麻酔学会
15.12.1995
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Abstract | 硬膜外持続鎮痛法を用いた上腹部術後患者26名を,術後3日間深呼吸だけを1日10回行なった群(DB群),トリフローIITMを1日5回行なった1群(TF I群)および1日10回行なった群(TF II群)の3群に分け,incentive spirometerを用いた術後早期の呼吸訓練が,術後の呼吸機能改善に有効かどうかを検討した.鎮痛効果は3群間に差はなく,深呼吸でも痛みを訴えない程度に維持された.呼吸機能について,肺活量,1秒率,最大呼気流速は,それぞれ3群間に有意差はなく,術後1日に術前値の50%に低下し,その後回復し術後10日で術前値の80%程度となった.PaO2は術前値に比べ術後3日間は低いままで推移し,DB群とTF II群で低い傾向がみられたが群間に有意差はなかった.Incentive spirometerによる術後早期呼吸訓練の呼吸機能改善効果は,硬膜外持続鎮痛法による十分な鎮痛状態下では,定期的な深呼吸法と同程度と考えられた. |
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AbstractList | 硬膜外持続鎮痛法を用いた上腹部術後患者26名を,術後3日間深呼吸だけを1日10回行なった群(DB群),トリフローIITMを1日5回行なった1群(TF I群)および1日10回行なった群(TF II群)の3群に分け,incentive spirometerを用いた術後早期の呼吸訓練が,術後の呼吸機能改善に有効かどうかを検討した.鎮痛効果は3群間に差はなく,深呼吸でも痛みを訴えない程度に維持された.呼吸機能について,肺活量,1秒率,最大呼気流速は,それぞれ3群間に有意差はなく,術後1日に術前値の50%に低下し,その後回復し術後10日で術前値の80%程度となった.PaO2は術前値に比べ術後3日間は低いままで推移し,DB群とTF II群で低い傾向がみられたが群間に有意差はなかった.Incentive spirometerによる術後早期呼吸訓練の呼吸機能改善効果は,硬膜外持続鎮痛法による十分な鎮痛状態下では,定期的な深呼吸法と同程度と考えられた. |
Author | 田勢, 長一郎 大槻, 学 赤津, 賢彦 奥秋, 晟 荻野, 英樹 |
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References | 12) Stock MC, Downs JB, Gauer PK, et al.: Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy. Chest 87: 151-157, 1985 18) Schwieger I, Gamulin Z, Forster A, et al.: Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy: A controlled randomized study. Chest 89: 652-656, 1986 19) Dureuil B, Viires N, Cantineau JP, et al.: Diaphrag-matic contractility after upper abdominal surgery. JAppl Physiol 61: 1775-1780, 1986 3) Meyers JR, Lembeck L, O'Kane H, et al.: Changes in functional residual capacity of the lung after operation. Arch Surg 110: 576-583, 1975 11) Zikria BA, Spencer JL, Kinney JM, et al.: Alterations in ventilatory function and breathing patterns following surgical trauma. Ann Surg 179: 1-7, 1974 15) Lyager S, Wernberg M, Rajani N, et al.: Can postoperative pulmonary conditions be improved by treatment with the Bartlett-Edwards incentive spirometer after upper abdominal surgery? Acta Anaesth Scand 23: 312-319, 1979 22) Lanz E, Simko G, Theiss D, et al.: Epidural buprenorphine-A double-blind study of postoperative analgesia and side effects. Anesth Analg 63 593-598, 1984 17) Celli BR, Rodriguez KS, Snider GL, et al.: A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 180 12-15, 1984 20) Pflug AE, Murphy TM, Bulter SH, et al.: The effects of postoperative peridural analgesia. on pulmonary therapy and pulmonary complications. Anesthesiology 41: 8-17, 1974 2) Ali J, Weisel RD, Layug AB, et al.: Consequences of postoperative alterations in respiratory mechan-ics. Am J Surg 128: 376-382, 1974 4) Alexander JI, Spence AA, Parikh RK, et al.: Therole of airway closure in postoperative hypoxemia. Br J Anaesth 45: 34-40, 1973 1) Pontoppidan H: Mechanical aids to lung expansion in nonintubated surgical patients. Am Rev Respir Dis 122: 109-119, 1980 7) Wahba WM, Don HF, Craig DB: Post-operative epidural analgesia: Effects on lung volumes. Canad Anaesth Soc J 22: 519-527, 1975 23) Jensen FM, Jensen N-H, Holk IK, et al.: Prolonged and biphasic respiratory depression following epidural buprenorphine. Anaesthesia 42: 470-475, 1987 8) Shulman M, Sandler AN, Bradley JW, et al.: Postthoracotomy pain and pulmonary function following epidural and systemic morphine. Anesthesiology 61: 569-575,1984 5) Craig DB: Postoperative recovery of pulmonary function. Anesth Analg 60: 46-52, 1981 9) Torda TA, Pybus DA: Extradural administration of morphine and bupivacaine: A controlled com-parison. Br J Anaesth 56: 141-146, 1984 21) Bonnet F, Blery C, Zatan M, et al.: Effect of epidural morphine on postoperative pulmonary dysfunction. Acta Anaesthesiol Scand 28: 147-151, 1984 13) Bartlett RG, Brennan ML, Gazzaniga AB, et al.: Studies on the pathogenesis and prevention of postoperative pulmonary complications. Surg Gynecol Obstet 1367: 925-933, 1973 14) Dohi S, Gold MI: Comparison of two methods of postoperative respiratory care. Chest 73: 592-595, 1978 10) El-Baz NM, Faber LP, Jensik RJ: Continuous epidural infusion of morphine for treatment of pain after thoracic surgery: A new technique. Anesth Analg 63: 757-764, 1984 16) Jung R, Wight J, Nusser R, et al.: Comparison of three methods of respiratory care following upper abdominal surgery. Chest 78: 31-35, 1980 6) 川野幸志,瀬在幸安:Incentive spirometer.呼吸 2: 523-526, 1983 |
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Title | 硬膜外持続鎮痛施行患者における術後早期呼吸訓練の効果 |
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