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1.
Ricardo Stein MD ScD Cristiano P. Maia PT MSc Anderson D. Silveira MD Gaspar R. Chiappa PT ScD Jonathan Myers PhD Jorge P. Ribeiro MD ScD 《Archives of physical medicine and rehabilitation》2009,90(10):1685-1691
Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery.
Objective
To evaluate the effects of a 6-day postoperative in-hospital cardiopulmonary rehabilitation program on inspiratory muscle strength and its potential association with improved functional capacity after coronary artery bypass graft (CABG) surgery.Design
Prospective, randomized controlled trial.Setting
Tertiary public hospital in Brazil.Participants
Men (N=20) after CABG were randomized to cardiopulmonary rehabilitation (n=10; age, 64±8y) or to usual care (n=10; age, 63±7y).Interventions
Ten subjects underwent a 6-day postoperative in-hospital program, which included the use of expiratory positive airway pressure mask and bronchial hygiene techniques, coupled with progressive distance walking and calisthenics as well as cardiopulmonary training. Ten controls were followed by their own physicians and received routine nursing assistance but were not exposed to any specific respiratory or motor physical intervention.Main Outcome Measures
Maximal inspiratory and expiratory pressure were measured by a pressure transducer, and the highest pressure obtained in 6 measurements was used for analysis (before surgery, and 7 and 30d after surgery). The six-minute walk test (6MWT) was performed 7 days after surgery, and maximal cardiopulmonary exercise testing was performed 30 days after CABG.Results
After randomization, clinical and functional characteristics were similar in the 2 groups. Rehabilitation resulted in maintenance of maximal inspiratory pressure (PImax) measured at 7 and 30 days postoperatively, respectively (from 68±19% at baseline to 58±22% and to 61±22% predicted), while it was significantly reduced in the control group. 6MWT distance was longer 7 days after CABG in rehabilitation subjects (416±78m) than controls (323±67m). Peak oxygen uptake (Vo2peak) at day 30 was also higher (28%) in the rehabilitation group and was correlated with PImax (r=.90).Conclusions
A 6-day rehabilitation program attenuated the postoperative reduction in respiratory muscle strength and also improved the recovery of functional capacity after CABG. The correlation between PImax and Vo2peak during the late postoperative period suggests that inspiratory muscle strength is an important determinant of functional capacity after CABG. 相似文献2.
Objective
To evaluate the effects of whole-body resistance training on exercise capacity, health-related quality of life (HRQOL), and muscle strength in patients hospitalized for exacerbation of chronic obstructive pulmonary disease.Design
Randomized controlled trial.Setting
University hospital.Participants
Patients (N=46) were randomized to either a control group (CG) or training group (TG), and 29 patients completed the study.Intervention
Training consisted of weight-lifting exercises for 6 muscle groups in the upper and lower limbs (2 sets of 8 repetitions each), and the initial load was set at 80% of the 1-repetition maximum load.Main Outcome Measures
Patients were evaluated on the second day of hospitalization, at hospital discharge, and 30 days postdischarge. Patients were evaluated on the basis of the 6-minute walking distance (6MWD), HRQOL, muscle strength, systemic inflammatory markers, and level of physical activity in daily life (PADL).Results
The CG showed a reduction in the strength of lower-limb muscles (P<.05) but not in the 6MWD (P>.05). In contrast, patients from the TG improved strength in the lower-limb muscles and 6MWD during and 30 days after hospitalization (P<.05). The TG also improved the impact domain in HRQOL after hospitalization. No improvement in PADL was observed in the TG. Finally, a reduction in the blood levels of inflammatory markers was observed only in the TG after hospitalization.Conclusions
Our results suggest that resistance training during hospitalization improves the 6MWD, HRQOL, and lower-limb muscle strength, without altering the levels of systemic inflammation. However, future research should explore this intervention in larger randomized trials. 相似文献3.
Dayane Montemezzo Guilherme Augusto Fregonezi Danielle Aparecida Pereira Raquel Rodrigues Britto W. Darlene Reid 《Archives of physical medicine and rehabilitation》2014
Objective
To determine whether the impact of inspiratory muscle weakness on inspiratory muscle training (IMT) affects inspiratory function and exercise capacity in chronic heart failure (CHF) patients.Data Sources
Electronic searches were performed using the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Cochrane Systematic Review, Embase, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases up to August 2013.Study Selection
Articles were included if participants had CHF and were >18 years old; the design was a randomized controlled trial; intervention was IMT; measurements were of inspiratory muscle function or exercise capacity; and the articles were published in English, Portuguese, or Spanish. Of the 1455 articles identified in the database searches, 9 studies met the inclusion criteria.Data Extraction
Two independent reviewers selected and extracted information from articles and assessed the quality of the studies using the PEDro scale. The 2 reviewers discussed disagreements until consensus was achieved.Data Synthesis
Meta-analyses compared IMT with controls/sham for maximal inspiratory pressure, sustained maximal inspiratory pressure, 6-minute walk distance, peak oxygen consumption, and minute ventilation after IMT. Subgroup analyses compared those with and without muscle weakness. CHF with inspiratory muscle weakness showed greater gains in the 6-minute walk distance and peak oxygen consumption compared with those with normative maximal inspiratory pressure. The mean quality analysis score was 7.1, and scores ranged from 6 to 10.Conclusions
The results emphasize the importance of evaluating the inspiratory muscles to identify patients with CHF and inspiratory muscle weakness; subgroup that showed better results after IMT. 相似文献4.
Purpose
The present study was performed to clarify the relationships between body mass index (BMI), interleukin-6 (IL-6) production, and respiratory muscle weakness in patients undergoing coronary artery bypass grafting (CABG).Materials and Methods
The correlations among BMI, changes in maximum inspiratory and expiratory pressure (ΔMIP, ΔMEP) on postoperative days (POD) 1 and 7, postoperative IL-6, and rapid turnover proteins (retinol-binding protein, prealbumin, and transferrin) on POD1 were assessed in 154 consecutive patients undergoing elective CABG. The patients were divided into quartiles of BMI, Q1 (BMI, <20.8 kg/m2) to Q4 (BMI, ≥25.25 kg/m2), and compared among groups.Results
There were significant correlations between ΔMIP and BMI (POD1, r = −0.369; POD7, r = −0.285) and IL-6 (POD1, r = 0.423; POD7, r = 0.431), and between ΔMEP and BMI (POD1, r = −0.252; POD7, r = −0.228) and IL-6 (POD1, r = 0.252; POD7, r = 0.384). Interleukin-6 showed a significant negative correlation with BMI (r = −0.374) and retinol-binding protein (r = −0.382). Interleukin-6 was highest in Q1 and lowest in Q4. Higher BMI indicated greater respiratory muscle strength than lower BMI.Conclusions
Preoperative BMI is correlated with respiratory muscle strength and cytokine production after CABG. The findings of this study suggest that BMI may be a valuable predictor for respiratory management in CABG patients. 相似文献5.
Roelof G.A. Ettema Heleen Van Koeven Linda M. Peelen Cor J. Kalkman Marieke J. Schuurmans 《International journal of nursing studies》2014
Objective(s)
The literature on postoperative complications in cardiac surgery patients shows high incidences of postoperative complications such as delirium, depression, pressure ulcer, infection, pulmonary complications and atrial fibrillation. These complications are associated with functional and cognitive decline and a decrease in the quality of life after discharge. Several studies attempted to prevent one or more postoperative complications by preoperative interventions. Here we provide a comprehensive overview of both single and multiple component preadmission interventions designed to prevent postoperative complications.Methods
We systematically reviewed the literature following the PRISMA statement guidelines.Results
Of 1335 initial citations, 31 were subjected to critical appraisal. Finally, 23 studies were included, of which we derived a list of interventions that can be applied in the preadmission period to effectively reduce postoperative depression, infection, pulmonary complications, atrial fibrillation, prolonged intensive care unit stay and hospital stay in older elective cardiac surgery patients. No high quality studies were found describing effective interventions to prevent postoperative delirium. We did not find studies specifically targeting the prevention of pressure ulcers in this patient population.Conclusions
Multi-component approaches that include different single interventions have the strongest effect in preventing postoperative depression, pulmonary complications, prolonged intensive care unit stay and hospital stay. Postoperative infection can be best prevented by disinfection with chlorhexidine combined with immune-enhancing nutritional supplements. Atrial fibrillation might be prevented by ingestion of N-3 polyunsaturated fatty acids. High quality studies are urgently needed to evaluate preadmission preventive strategies to reduce postoperative delirium or pressure ulcers in older elective cardiac surgery patients. 相似文献6.
Kazuki Okura Yusuke Takahashi Kazutoshi Hatakeyama Kimio Saito Yuji Kasukawa Kazuhiro Imai Yoshihiro Minamiya 《Physiotherapy research international》2023,28(2):e1987
Introduction
Sarcopenia and chronic obstructive pulmonary disease (COPD) are risk factors for postoperative pulmonary complications (PPCs). Preoperative inspiratory muscle weakness is also a risk factor for PPCs. Sarcopenia and COPD are often associated with inspiratory muscle weakness. Respiratory sarcopenia has been defined as the coexistence of whole-body sarcopenia and respiratory muscle weakness. We report our experience with preoperative pulmonary rehabilitation, including inspiratory muscle training (IMT), in a patient with lung cancer and comorbid respiratory sarcopenia and COPD.Case presentation
A 73-year-old man with squamous cell lung cancer (cStage IA2) was hospitalized for pulmonary rehabilitation before lung resection. He had comorbid severe sarcopenia and COPD (GOLD stage III). He also had inspiratory muscle weakness and a thin diaphragm. We conducted IMT on the patient in addition to aerobic exercise and instruction regarding sputum expectoration for 2 weeks before the surgery. Consequently, his pulmonary function, respiratory muscle strength, and exercise capacity improved. Segmentectomy was performed using video-assisted thoracic surgery. No postoperative complications occurred.Conclusion
IMT in a patient with lung cancer and comorbid respiratory sarcopenia and COPD resulted in improved respiratory muscle strength and pulmonary function. IMT may have reduced the risk of PPCs by strengthening the respiratory muscles and improving pulmonary function.7.
Andrew D. Ray Supriya Udhoji Terry L. Mashtare Nadine M. Fisher 《Archives of physical medicine and rehabilitation》2013
Objective
To determine the effects of a short-duration, combined (inspiratory and expiratory), progressive resistance respiratory muscle training (RMT) protocol on respiratory muscle strength, fatigue, health-related quality of life, and functional performance in individuals with mild-to-moderate multiple sclerosis (MS).Design
Quasi-experimental before-after trial.Setting
University rehabilitation research laboratory.Participants
Volunteers with MS (N=21) were divided into 2 groups: RMT (n=11; 9 women, 2 men; mean age ± SD, 50.9±5.7y, mean Expanded Disability Status Scale score ± SD, 3.2±1.9) and a control group that did not train (n=10; 7 women, 3 men; mean age ± SD, 56.2±8.8y, mean Expanded Disability Status Scale score ± SD, 4.4±2.1). Expanded Disability Status Scale scores ranged from 1 to ≤6.5. No patients withdrew from the study.Intervention
Training was a 5-week combined progressive resistance RMT program, 3d/wk, 30 minutes per session.Main Outcome Measures
The primary outcome measures were maximal inspiratory pressure and expiratory pressure and the Modified Fatigue Impact Scale. All subjects completed secondary measures of pulmonary function, the six-minute walk test, the timed stair climb, the Multiple Sclerosis Self-Efficacy Scale, the Medical Outcomes Study 36-Item Short-Form Health Survey, and the Physical Activity Disability Scale.Results
Maximal inspiratory pressure and expiratory pressure (mean ± SD) increased 35%±22% (P<.001) and 26%±17% (P<.001), respectively, whereas no changes were noted in the control group (12%±23% and −4%±17%, respectively). RMT improved fatigue (Modified Fatigue Impact Scale, P<.029), with no change or worsening in the control group. No changes were noted in the six-minute walk test, stair climb, Multiple Sclerosis Self-Efficacy Scale, or Physical Activity Disability Scale in the RMT group. The control group had decreases in emotional well-being and general health (Medical Outcomes Study 36-Item Short-Form Health Survey).Conclusions
A short-duration, combined RMT program improved inspiratory and expiratory muscle strength and reduced fatigue in patients with mild to moderate MS. 相似文献8.
Karin Postma Janneke A. Haisma Sonja de Groot Maria T. Hopman Michael P. Bergen Henk J. Stam Johannes B. Bussmann 《Archives of physical medicine and rehabilitation》2013
Objective
To describe changes in pulmonary function (PF) during the 5 years after inpatient rehabilitation in persons with spinal cord injury (SCI) and to study potential determinants of change.Design
Prospective cohort study.Setting
Eight rehabilitation centers with specialized SCI units.Participants
Persons with SCI (N=180).Interventions
Not applicable.Main Outcome Measures
PF was determined by forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) as a percentage of the predicted value, at the start of rehabilitation, at discharge, and 1 and 5 years after discharge from inpatient rehabilitation. The population was divided into 3 subgroups on the basis of whether their PF declined, stabilized, or improved.Results
FVC improved on average 5.1% over the whole period between discharge of inpatient rehabilitation and 5 years thereafter, but changes differed largely between persons. FVC declined in 14.9% of the population during the first year after discharge. During this year, body mass index, inspiratory muscle strength, change in peak power output, and change in peak oxygen uptake differed significantly between subgroups. FVC declined in 28.3% of the population during the following 4 years, but no differences were found between the subgroups for this period. Subgroups based on changes in FEV1 differed only with respect to change in peak oxygen uptake the first year after discharge.Conclusions
In our study, many persons with SCI showed a decline in PF, larger than the normal age-related decline, during the 5 years after inpatient rehabilitation. Results suggest that a decline in PF during the first year after inpatient rehabilitation is associated with higher body mass index, lower inspiratory muscle strength, and declined physical fitness. 相似文献9.
Karen Moraes Denise M. Paisani Nathália C. T. Pacheco Luciana D. Chiavegato 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2015,19(4):264-270
BACKGROUND:
A living donor transplant improves the survival and quality of life of a transplant patient. However, the impact of transplantation on postoperative lung function and respiratory muscular strength in kidney donors remains unknown.OBJECTIVE:
To evaluate pulmonary function, respiratory muscle strength, quality of life and the incidence of postoperative pulmonary complications (PPCs) in kidney donors undergoing nephrectomy.METHOD:
This prospective cohort enrolled 110 consecutive kidney donors undergoing nephrectomy. Subjects underwent pulmonary function (using spirometry) and respiratory muscular strength (using manovacuometry) assessments on the day prior to surgery and 1, 2, 3 and 5 days postoperatively. Quality of life (measured by the SF-36) was evaluated preoperatively and 30 days postoperatively. PPCs were assessed daily by a blinded assessor.RESULTS:
Donors exhibited a decrease of 27% in forced vital capacity, 58% in maximum inspiratory capacity and 51% in maximum expiratory pressure on the 1stpostoperative day (p<0.001) but this improved over days 2, 3 and 5 but had not returned to preoperative levels. Patient quality of life was still impaired at 30 days with regards to functional capacity, physical role, pain, vitality and social functioning (p<0.05) but these parameters improved slowly. None of the patients developed PPCs.CONCLUSION:
Kidney donors submitted to nephrectomy exhibited a reduction in pulmonary function, respiratory muscular strength and quality of life, most of which were improving toward pre-surgical levels. 相似文献10.
Tim Montrief Alex Koyfman Brit Long 《The American journal of emergency medicine》2018,36(12):2289-2297
Introduction
Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery.Objective
This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications.Discussion
While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30?days of discharge with post-operative complications. Risk factors for perioperative mortality and morbidity after CABG surgery can be divided into three categories: patient characteristics, clinician characteristics, and postoperative factors. Emergency physicians will be faced with several postoperative complications, including sternal wound infections, pneumonia, thromboembolic phenomena, graft failure, atrial fibrillation, pulmonary hypertension, pericardial effusion, strokes, renal injury, gastrointestinal insults, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary surgical team is needed, which improves patient outcomes. This review provides several guiding principles for management of acute complications. Understanding these complications and an approach to the management of hemodynamic instability is essential to optimizing patient care.Conclusions
Postoperative complications of CABG surgery can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Early surgical consultation is imperative, as is optimizing the patient's hemodynamics, including preload, heart rate, cardiac rhythm, contractility, and afterload. 相似文献11.
Background
Surgery for cancer of the thoracic esophagus is a challenging procedure associated with high morbidity and mortality. Perioperative rehabilitation has been introduced to promote early mobilization of the patients and to prevent postoperative pulmonary complications. The purpose of the present study was to characterize the preoperative functional exercise capacity, muscle strength, anxiety, depression, and health-related quality of life (QOL) in patients with esophageal cancer, and to evaluate the impact of radical esophagectomy on these parameters.Methods
We performed a retrospective review of 34 consecutive patients with newly diagnosed resectable esophageal cancer who underwent esophagectomy followed by postoperative rehabilitation from January to December 2014. Patients were tested for 6-min walk distance (6MWD), knee-extensor muscle strength, hand grip strength, the Hospital Anxiety and Depression Scale (HADS), and the chronic obstructive pulmonary disease (COPD) assessment test (CAT) before and two weeks after the surgery. Before surgery, the pulmonary function test, and components of the MOS 36-item Short-Form Health Survey (SF-36) Questionnaire for general health were assessed.Results
The mean age was 67.3?±?8.1 years. The patients were predominantly male (76.4 %), had high rates of smoking history (91.2 %), and squamous cell carcinoma (97.1 %). The predicted value for forced expiratory volume in 1 s was 94.0?±?15.9 %, and 12 patients (35.3 %) had COPD. The clinical stage was 0-I in 12 patients, II in 4 patients, III in 16 patients, and IV in 2 patients. Thirty-one patients (91.2 %) underwent open surgery. At the baseline, components of the SF-36 scores significantly correlated with CAT and HADS scores, and the physical status was significantly poorer in patients with COPD than those without. Comparisons between the preoperative and postoperative values revealed significant decreases in 6MWD, hand grip strength, isometric knee extensor muscle strength, and a significant increase in CAT scores but not in HADS scores after surgery. In multiple regression analysis, decreases in 6MWD after the surgery significantly correlated with the preoperative physical component summary of SF-36.Conclusions
Our results indicate that surgery remained detrimental to health outcomes at two weeks. Further research should investigate whether prehabilitation would improve the postoperative outcomes, QOL, and physical fitness.12.
Lívia ArcêncioDaniella Alves Vento MS Solange BassettoPaulo R.B. Évora MD PhD Alfredo José Rodrigues 《Journal of critical care》2013
Purpose
The purposes of this study are to measure the nitric oxide metabolites nitrite and nitrate (NOx) in the exhaled breath condensates (EBCs) of patients submitted to heart valve surgery and to assess the correlation between NOx levels and postoperative respiratory complications.Materials and Methods
Exhaled breath condensate and blood samples were collected from each patient during spontaneous breathing preoperatively, during invasive mechanical ventilation in the fourth hour after surgery and 12, 24, 48, and 72 hours after the operation. Nitrite and nitrate levels in the EBC and serum were measured by chemiluminescence.Results
Thirty-two patients were included in the study. In patients who presented with postoperative respiratory complications, the postoperative levels of NOx were significantly higher in the EBC from the fourth postoperative hour compared with those who experienced uneventful postoperative periods (P = .027). However, the preoperative and postoperative serum levels of NOx were not significantly different in between-group analyses (P = .995).Conclusion
Our results suggest that the postoperative NOx level in the EBC is an early marker of respiratory complications after heart valve surgery. Additional studies using large cohorts are necessary to corroborate our results and to better define the clinical usefulness of assessing NOx in the EBC after cardiac surgery. 相似文献13.
14.
Ekaterina Tankisheva An Bogaerts Steven Boonen Hilde Feys Sabine Verschueren 《Archives of physical medicine and rehabilitation》2014
Objectives
To investigate the effects of a 6-week whole body vibration (WBV) training program in patients with chronic stroke.Design
Randomized controlled pilot trial with 6 weeks' follow-up.Setting
University hospital.Participants
Adults with chronic stroke (N=15) were randomly assigned to an intervention (n=7) or a control group (n=8).Interventions
Supervised, intensive WBV training. The vibration group performed a variety of static and dynamic squat exercises on a vibration platform with vibration amplitudes of 1.7 and 2.5mm and frequencies of 35 and 40Hz. The vibration lasted 30 to 60 seconds, with 5 to 17 repetitions per exercise 3 times weekly for 6 weeks. Participants in the control group continued their usual activities and were not involved in any additional training program.Main Outcome Measures
The primary outcome variable was the isometric and isokinetic muscle strength of the quadriceps (isokinetic dynamometer). Additionally, hamstrings muscle strength, static and dynamic postural control (dynamic posturography), and muscle spasticity (Ashworth Scale) were assessed.Results
Compliance with the vibration intervention was excellent, and the participants completed all 18 training sessions. Vibration frequencies of both 35 and 40Hz were well tolerated by the patients, and no adverse effects resulting from the vibration were noted. Overall, the effect of intensive WBV intervention resulted in significant between-group differences in favor of the vibration group only in isometric knee extension strength (knee angle, 60°) (P=.022) after 6 weeks of intervention and in isokinetic knee extension strength (velocity, 240°/s) after a 6-week follow-up period (P=.005), both for the paretic leg. Postural control improved after 6 weeks of vibration in the intervention group when the patients had normal vision and a sway-referenced support surface (P<.05). Muscle spasticity was not affected by vibration (P>.05).Conclusions
These preliminary results suggest that intensive WBV might potentially be a safe and feasible way to increase some aspect of lower limb muscle strength and postural control in adults with chronic stroke. Further studies should focus on evaluating how the training protocol should be administered to achieve the best possible outcome, as well as comparing this training protocol to other interventions. 相似文献15.
Florian Weis Erich Kilger Andres Beiras-Fernandez Christian L. Hinske Kirsten Nassau Lahib Adnan Calin Vicol Felix Kur Patrick Möhnle 《Journal of critical care》2014
Purpose
To evaluate the role of plasma disappearance rate of indocyanine green (PDR-ICG) as an outcome prediction tool in cardiac surgery.Patients and Methods
One hundred ninety patients undergoing coronary artery bypass grafting, valve surgery or combined procedures were enrolled. PDR-ICG measurements along with standard lab values were performed preoperative and on postoperative days 1, 2, and on discharge from the intensive care unit. Adverse outcomes were defined as prolonged length of stay in the intensive care unit and/or mortality. Two groups were defined according to length of stay in the intensive care unit (≤ 3 days vs > 3 days).Results
PDR-ICG values differed significantly for all time points between the groups. In a multivariate model, in patients over 65 years with a EuroSCORE below 8.5, a preoperative PDR-ICG value below 12.85%/min was the strongest independent predictor for prolonged intensive care unit stay (> 3 days). A preoperative PDR-ICG value below 8.2%/min was the strongest independent predictor for mortality in a multivariate analysis including age, cardiac function, and EuroSCORE.Conclusions
In addition to the established scores, PDR-ICG may provide valuable information for the assessment of perioperative morbidity and mortality in cardiac surgery. Pre- and early postoperative measurements may help to identify patients at risk for developing perioperative complications. 相似文献16.
17.
Effect of intraoperative dobutamine on splanchnic tissue perfusion and outcome after Whipple surgery
Amal Rashad Reyad Walaa Elkharboutly Ashraf Wahba Mohamed Elmorshedi Nadia A. Hasaneen 《Journal of critical care》2013
Purpose
Splanchnic hypoperfusion during abdominal surgery contributes to postoperative gut sepsis and mortality. Dobutamine is an inotrope with vasodilator properties that improve hepatosplanchnic perfusion. The aim of this study was to examine the effect of intraoperative dobutamine infusion during Whipple surgery on splanchnic perfusion, hemodynamic, and overall postoperative outcome.Methods
Sixty patients were randomly allocated to receive intraoperatively (3 μg/kg per minute or 5 μg/kg per minute) doses of dobutamine or saline. Baseline measurements included hemodynamic parameters, gastric tonometric parameters, and arterial and mixed venous gases. These patients had a follow-up for development for in-hospital morbidity and mortality.Results
Intraoperative use of dobutamine increased oxygen-derived parameters as evidenced by increased mixed venous oxygen saturation. Tonometered gastric mucosal pH, a surrogate for splanchnic perfusion, increased in patients who received intraoperative dobutamine. Patients in the dobutamine groups demonstrated significant higher heart rates, premature ventricular contraction arrhythmias, and electrocardiographic signs of ischemia. Mean arterial blood pressure demonstrated no significant difference among groups. The overall incidence of postoperative complications was higher in control group 70 % vs 20% to 40% in dobutamine groups.Conclusion
Intraoperative use of dobutamine improved global oxygen delivery, splanchnic perfusion, and postoperative outcome after Whipple surgery. These findings may be of clinical importance when the therapeutic goal is to improve gut perfusion. 相似文献18.
Eva Kennis Sabine M. Verschueren An Bogaerts Evelien Van Roie Steven Boonen Christophe Delecluse 《Archives of physical medicine and rehabilitation》2013
Objective
To evaluate the long-term preventive impact of strength training on muscle performance in older adults.Design
A 7-year follow-up on a 1-year randomized controlled trial comparing the effects of combined resistance training and aerobic training and whole-body vibration training on muscle performance.Setting
University training center.Participants
Men and women (N=83; control [CON] group, n=27; strength-training intervention [INT] group, n=56) between 60 and 80 years of age.Interventions
The INT group exercised 3 times weekly during 1 year, performing a combined resistance training and aerobic training program or a whole-body vibration training program. The former training program was designed according to American College of Sports Medicine guidelines. The whole-body vibration training program included unloaded static and dynamic leg exercises on a vibration platform. The CON group did not participate in any training program.Main Outcome Measures
Static strength (STAT), dynamic strength at 60°/s (DYN60) and at 240°/s (DYN240), speed of movement at 20% (S20).Results
From baseline to postintervention, muscle performance did not change in the CON group, except for S20 (+6.55%±2.88%, P<.001). One year of strength training increased (P≤.001) STAT (+11.46%±1.86%), DYN60 (+6.96%±1.65%), DYN240 (+9.25%±1.68%), and S20 (+7.73%±2.19%) in the INT group. Between baseline and follow-up, muscle performance decreased (P<.001) in both groups. However, STAT and DYN60 showed a significantly lower loss in the INT group (−8.65%±2.35% and −7.10%±2.38%, respectively) compared with the CON group (−16.47%±2.69% and −15.08%±2.27%, respectively). This positive impact might be due to the preservation of the training-induced gains, given the similar annual decline rates in both groups from postintervention to follow-up. Additionally, in trained participants, aging seems to impact velocity-dependent strength and power more compared with basic strength, as the total losses in DYN240 (CON, −15.93%±2.64%; INT, −11.39%±1.95%) and S20 (CON, −14.39%±2.10%; INT, −13.16%±1.72%) did not differ significantly between the groups.Conclusions
A 1-year strength-training intervention results in an improved muscle performance in older adults 7 years after their enrollment in the intervention. However, an extensive exercise program cannot attenuate the age-related decline once the intervention stops. 相似文献19.
Judson B. Williams Eric D. Peterson Daniel Wojdyla Ralf Harskamp Kevin W. Southerland T. Bruce Ferguson Peter K. Smith Carmelo A. Milano Renato D. Lopes 《Journal of critical care》2014
Objective
Although hemodynamic monitoring is often performed after coronary artery bypass grafting (CABG), the role of monitoring postoperative central venous pressure (CVP) measurement as a predictor of clinical outcomes is unknown. As such, this study tests the hypothesis that postoperative CVP is predictive of operative mortality or renal failure.Methods
This is an observational cohort study of detailed clinical data from 2390 randomly selected patients undergoing high-risk CABG or CABG/valve at 55 hospitals participating in the Society of Thoracic Surgeons' National Cardiac Surgery Database 2004-2005. Eligible patients underwent elective/urgent CABG with an ejection fraction less than 40% or elective/urgent CABG at 65 years or older with diabetes or a glomerular filtration rate less than 60 mL/min per 1.73 m2. The exposure of interest is CVP monitoring in the intensive care unit after adult cardiac surgery. The primary outcome measure was correlation between postoperative CVP and inhospital/30-day mortality and renal failure, assessed as a continuous variable, both unadjusted and after adjusting for important clinical factors using logistic regression modeling.Results
Mean age was 72 years, 54% of patients had diabetes mellitus, 49% were urgent procedures, and mean cardiopulmonary bypass time was 105 minutes. Patients' CVP 6 hours postoperation was strongly associated with inhospital and 30-day mortality: odds ratio (OR) of 1.5 (95% confidence interval [CI], 1.23-1.87) for every 5-mm Hg increase in CVP; P < .0001. This association remained significant after risk adjustment: adjusted OR of 1.44 (95% CI, 1.10-1.89); P < .01. A model adjusting for cardiac index also revealed increased incidence of mortality or renal failure: adjusted OR of 1.5 (95% CI, 1.28-1.86) for every 5-mm Hg increase in CVP; P < .0001.Conclusions
Patients' CVP at 6 hours after CABG surgery was highly predictive of operative mortality or renal failure, independent of cardiac index and other important clinical variables. Future studies will need to assess whether interventions guided by postoperative CVP can improve patient outcomes. 相似文献20.
Muserrefe Nur Keles Bulent Elbasan Umut Apaydin Zeynep Aribas Arzu Bakirtas Nurdan Kokturk 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(6):493-501