| Objective:To evaluate the effects of three different respiratory training methods on pulmonary function status,incidence of pulmonary complications,pain score,abdominal distension score and first anal exhaust time after operation in patients undergoing radical gastrectomy.Methods:From December 2017 to December 2018,84 patients undergoing radical gastrectomy in gastrointestinal surgery department of Yi-xing People’s Hospital,patients were selected and randomly divided into control group(n=28),exhalatory breathing training group(n=28)and inspiratory breathing training group(n=28).In addition to routine nursing care,the control group received abdominal breathing training since admission to the hospital,and the two groups received deep exhalatory breathing training and deep inspiratory breathing training,respectively.The pulmonary function(PEF,FVC,FEV1%),blood gas analysis(PaO2,PaCO2,SaO2,PH),incidence of postoperative pulmonary complications,pain,abdominal distension and first anal exhaust time of the three groups was compared with the day of admission to the hospital,the 1st day after operation and the 6th day after operation.Results:1.There were 2 cases missing in the control group,2 cases missing in the inspiratory breathing training group and 3 cases missing in the exhalatory breathing training group.77 cases in the three groups completed the test,that is,26 cases in the control group,26 cases in the inspiratory breathing training group and 25 cases in the exhalatory breathing training group.There was no significant difference in baseline data among the three groups(P>0.05).2.Lung function①comparison in groups:On the 1st day after operation,the PEF,FVC,FEV1%of the three groups was significantly lower than that on admission to hospital,and the PEF,FVC,FEVi%of the three groups on the 6th day after operation was significantly higher than that on the 1st day after operation(P<0.05).On the 6th day after operation,PEF,FVC,FEV1%in the control group was significantly lower than that on admission to hospital.FVC of exhalatory breathing training group was significantly lower than that of admission(P<0.05),PEF and FEV1%were not significantly different from that of admission(P>0.05).PEF and FEV1%in the inspiratory breathing training group were significantly lower than that at admission(P<0.05),and FVC was not significantly different from that at admission(P>0.05).②comparison among groups:On the 1st day after operation,FEV1%,FVC in exhalatory breathing training group and inspiratory breathing training group was significantly higher than that in control group(P<0.05).There was no difference between exhalatory breathing training group and inspiratory breathing training group in FEV1%and FVC.There was no difference in PEF between the inspiratory breathing training group and the control group(P>0.05),PEF in exhalatory breathing training group was significantly higher than that in control group(P<0.05).On the 6th day after operation,PEF,FVC,FEV1%in inspiratory breathing training group was significantly higher than that in control group,and PEF,FVC,FEV1%in exhalatory breathing training group was significantly higher than that in control group(P<0.05).The PEF,FEV1%in the exhalatory breathing training group was significantly higher than that in the inspiratory breathing training group(P<0.05),and the FVC in the inspiratory breathing training group was significantly higher than that in the exhalatory breathing training group(P<0.05).3.Blood gas analysis①comparison in group:On the 1 st day after operation,the SaO2,PaO2 and PH of the three groups was significantly lower than that at admission(P<0.05),and PaCO2 was significantly higher than that at admission(P<0.05),On the 6th day after operation,the SaO2,PaO2 and PH of the three groups was significantly higher than that of the 1st day after operation(P<0.05).PaCO2 was significantly lower than that on the first day after operation(P<0.05).On the 6th day after the operation,there was no significant difference in SaO2 and PaO2 in the three groups compared with that at admission(P>0.05).PaCO2 in the control group and the inspiratory breathing training group was significantly higher than that at admission(P<0.05).PH was significantly lower than that at admission(P<0.05).There was no difference in PaCO2 and PH between the exhalatory breathing training group and that at admission(P>0.05).②comparison among groups:On the 1st day after operation,there was no significant difference in SaO2,PaO2,PH and PaCO2 between the three groups.On the 6th day after the operation,SaO2 and PaO2 in the inspiratory breathing training group and the exhalatory breathing training group were significantly higher than those in the control group(P<0.05),while there was no significant difference between the inspiratory breathing training group and the exhalatory breathing training group(P>0.05).PaCO2 of the exhalatory breathing training group was significantly lower than that of the control group and the inspiratory breathing training group(P<0.05),and PH of the exhalatory breathing training group was significantly higher than that of the control group and the inspiratory breathing training group(P<0.05).There was no difference in PaCO2 and PH between the inspiratory breathing training group and the control group(P>0.05).4、Pulmonary complicationsThere were 3 patients in the three groups with pneumonia after operation,including 2 patients in the control group,0 patients in the inspiratory breathing training group and 1 patient in the exhalatory breathing training group.There was no significant difference in the number of postoperative pneumonia complications among the three groups(P>0.05).5、Pain score①comparison in groups:On the 1st day after operation,the average pain score after training in inspiratory breathing training group and exhalatory breathing training group was significantly higher than that before training(P<0.05),but there was no significant difference in pain score between control group after training(P>0.05).On the 2nd day after operation,the pain score after training in the inspiratory breathing training group was significantly higher than that before training(P<0.05),but there was no significant difference between the exhalatory breathing training group and the control group before and after training(P>0.05),what is more,there was no significant difference among the three groups from the 3rd day to the 6th day after operation(P>0.05).②comparison among groups:There was no significant difference in pain scores between the three groups before and after breathing training(P>0.05).6、Abdominal distension scoreThere was no significant difference among the three groups on the 1 st and 2nd day after operation(P>0.05).On the 3rd and 4th day after operation,the abdominal distension scores of inspiratory breathing training group and exhalatory breathing training group were significantly lower than those of control group(P<0.05),but there was no difference between inspiratory breathing training group and exhalatory breathing training group(P>0.05).There was no significant difference among the three groups on the 5th and 6th day after operation(P>0.05).7、First anal exhaust timeThe first anal exhaust time was 70.77±8.65,64.62±7.12,60.84±7.45h respectively.Compared with the control group,the first anal exhaust time was significantly shorter in the exhalatory breathing training group and the inspiratory breathing training group,There were differences in statistics(P<0.05).There was no difference between inspiratory breathing training group and expiratory training group(P>0.05).Conclusion:Deep exhalatory breathing training and deep inspiratory breathing training with respiratory trainer can effectively improve the pulmonary function and blood gas analysis indexes of patients with gastric cancer after operation.In improving respiratory index(PEF,FEV1%and PaCO2),deep exhalatory breathing training is superior to deep inspiratory breathing training,and in improving respiratory index(FVC),deep inspiratory breathing training is superior to deep exhalatory breathing training.At the same time,both can shorten the first anal exhaust time and reduce abdominal distension,but early stage can increase postoperative pain and can not significantly reduce the incidence of postoperative pulmonary complications. |
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