Curative effect of intrapulmonary percussion ventilation in patients with mechanical ventilation after upper abdominal surgery

doi:10.3877/cma.j.issn.1674-6880.2023.06.005

Abstract

Abstract:

Objective

To explore the therapeutic effect of intrapulmonary percussion ventilation (IPV) in patients with mechanical ventilation after upper abdominal surgery.

Methods

A total of 68 patients with mechanical ventilation after upper abdominal surgery admitted to the Department of Critical Care Medicine in the Sir Run Run Hospital, Nanjing Medical University from December 2021 to December 2022 were selected, who were divided into a observation group (34 cases) and a control group (34 cases) by a random number table method. Patients in the observation group were treated with IPV and patients in the control group were treated with conventional chest physiotherapy. The sputum volume, oxygenation index, arterial partial pressure of carbon dioxide (PaCO₂) and airway peak pressure before treatment and at 1, 3 and 5 d after treatment were compared between the two groups, as well as the incidence of atelectasis and pneumonia, duration of mechanical ventilation, length of ICU stay and 28 d mortality. Then the systolic blood pressure, heart rate and respiratory rate were compared between the two groups before and after treatment.

Results

There were significant differences in the sputum volume, oxygenation index, PaCO₂ and airway peak pressure before treatment and at 1, 3 and 5 d after treatment between the observation group and control group (F = 28.606, 30.316, 18.276, 21.143; P = 0.014, 0.008, 0.026, 0.018). Further pairwise comparisons found that the sputum volume and oxygenation index in the observation group were significantly higher than those in the control group at 1, 3 and 5 d after treatment, while the PaCO₂ and airway peak pressure were significantly lower (all P < 0.05). The incidence of postoperative atelectasis [11.76% (4/34) vs. 23.53% (8/34), χ² = 3.245, P = 0.011], incidence of pneumonia [8.82% (3/34) vs. 17.65% (6/34), χ² = 2.632, P = 0.018], duration of mechanical ventilation [(36 ± 24) h vs. (73 ± 40) h, t = 3.726, P = 0.012] and length of ICU stay [(5.4 ± 2.6) d vs. (7.4 ± 3.1) d, t = 2.123, P = 0.034] in the observation group were significantly lower than those in the control group. However, there were no significant differences in the systolic blood pressure [(128 ± 13) mmHg vs. (125 ± 10) mmHg, t = 1.323, P = 0.287], heart rate [(88 ± 6) beats/min vs. (87 ± 13) beats/min, t = 3.154, P = 0.072], respiratory rate [(20 ± 6) breaths/min vs. (19 ± 5) breaths/min, t = 1.018, P = 0.351] and 28 d mortality [2.94% (1/34) vs. 5.88% (2/34), χ² = 1.024, P = 0.175] between the observation group and control group after treatment.

Conclusion

IPV can promote sputum excretion, improve oxygenation and ventilation function, reduce the incidence of atelectasis and pneumonia, and shorten the duration of mechanical ventilation and ICU stay in mechanically ventilated patients after upper abdominal surgery, which is safe and tolerable.

Key words: Intrapulmonary percussion ventilation, Epigastric surgery, Mechanical ventilation, Postoperative pulmonary complications, Atelectasis

Xiang Xue, Jiao Chen, Ling Jia, Jinghui Yang, Jianqin Cai, Kunlun Chen, Wei Zhao. Curative effect of intrapulmonary percussion ventilation in patients with mechanical ventilation after upper abdominal surgery[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(06): 469-474.

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References 21

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组别	例数	年龄（岁， ± s）	性别（例，男/女）	吸烟[例（%）]	COPD[例（%）]	哮喘[例（%）]	肥胖[例（%）]	OSAS[例（%）]
观察组	34	66 ± 24	20/14	12（35.29）	7（20.59）	4（11.76）	8（23.53）	4（11.76）
对照组	34	63 ± 20	18/16	10（29.41）	6（17.65）	5（14.71）	6（17.65）	3（8.82）
t/χ²值		1.725	2.234	2.245	0.854	1.476	2.156	1.813
P值		0.185	0.128	0.125	0.307	0.216	0.135	0.204
组别	例数	ASA分级[例（%）]			手术类型[例（%）]
组别	例数	ASA 2级+并发症	ASA 3级	ASA 4级/ASA 5级	胃十二指肠手术	胆道胰腺手术	肝脾手术
观察组	34	7（20.59）	22（64.71）	5（14.71）	19（55.88）	9（26.47）	6（17.65）
对照组	34	9（26.47）	21（61.76）	4（11.76）	17（50.00）	10（29.41）	7（20.59）
t/χ²值		1.054	2.549	1.723	1.835	1.942	2.726
P值		0.278	0.105	0.184	0.212	0.187	0.134

组别	例数	年龄（岁， ± s）	性别（例，男/女）	吸烟[例（%）]	COPD[例（%）]	哮喘[例（%）]	肥胖[例（%）]	OSAS[例（%）]
观察组	34	66 ± 24	20/14	12（35.29）	7（20.59）	4（11.76）	8（23.53）	4（11.76）
对照组	34	63 ± 20	18/16	10（29.41）	6（17.65）	5（14.71）	6（17.65）	3（8.82）
t/χ²值		1.725	2.234	2.245	0.854	1.476	2.156	1.813
P值		0.185	0.128	0.125	0.307	0.216	0.135	0.204
组别	例数	ASA分级[例（%）]			手术类型[例（%）]
组别	例数	ASA 2级+并发症	ASA 3级	ASA 4级/ASA 5级	胃十二指肠手术	胆道胰腺手术	肝脾手术
观察组	34	7（20.59）	22（64.71）	5（14.71）	19（55.88）	9（26.47）	6（17.65）
对照组	34	9（26.47）	21（61.76）	4（11.76）	17（50.00）	10（29.41）	7（20.59）
t/χ²值		1.054	2.549	1.723	1.835	1.942	2.726
P值		0.278	0.105	0.184	0.212	0.187	0.134

组别	例数	痰量（mL）	氧合指数（mmHg）	PaCO₂（mmHg）	气道峰压（mmHg）
观察组
治疗前	34	31 ± 5	189 ± 32	47 ± 7	18 ± 4
治疗后1 d	34	37 ± 5^a	233 ± 28^a	41 ± 5^a	13 ± 3^a
治疗后3 d	34	37 ± 5^a	258 ± 25^a	37 ± 5^a	12 ± 4^a
治疗后5 d	34	33 ± 4^a	281 ± 30^a	36 ± 6^a	13 ± 4^a
对照组
治疗前	34	33 ± 4	195 ± 36	46 ± 6	17 ± 5
治疗后1 d	34	34 ± 5	212 ± 22	43 ± 6	16 ± 4
治疗后3 d	34	36 ± 3	233 ± 27	40 ± 5	15 ± 3
治疗后5 d	34	28 ± 5	251 ± 25	39 ± 4	16 ± 5
F值		28.606	30.316	18.276	21.143
P值		0.014	0.008	0.026	0.018

组别	例数	痰量（mL）	氧合指数（mmHg）	PaCO₂（mmHg）	气道峰压（mmHg）
观察组
治疗前	34	31 ± 5	189 ± 32	47 ± 7	18 ± 4
治疗后1 d	34	37 ± 5^a	233 ± 28^a	41 ± 5^a	13 ± 3^a
治疗后3 d	34	37 ± 5^a	258 ± 25^a	37 ± 5^a	12 ± 4^a
治疗后5 d	34	33 ± 4^a	281 ± 30^a	36 ± 6^a	13 ± 4^a
对照组
治疗前	34	33 ± 4	195 ± 36	46 ± 6	17 ± 5
治疗后1 d	34	34 ± 5	212 ± 22	43 ± 6	16 ± 4
治疗后3 d	34	36 ± 3	233 ± 27	40 ± 5	15 ± 3
治疗后5 d	34	28 ± 5	251 ± 25	39 ± 4	16 ± 5
F值		28.606	30.316	18.276	21.143
P值		0.014	0.008	0.026	0.018

组别	例数	收缩压（mmHg）	心率（次/min）	呼吸频率（次/min）
观察组
治疗前	34	121 ± 14	82 ± 11	18 ± 3
治疗后	34	128 ± 13	88 ± 6	20 ± 6
对照组
治疗前	34	117 ± 12	80 ± 11	16 ± 5
治疗后	34	125 ± 10	87 ± 13	19 ± 5

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