Analysis of the results of the study showed that the second day post-surgery is characterized by a marked decrease in volumetric and velocity respiratory flow values in all the groups studied, in comparison with pre-surgery studies. For example, on the second day post-surgery in groups I, II and III vital capacity decreased by 42%, 35%, 34% (P < 0.01), and forced vital capacity - by 46%, 32%, 35% (P < 0.01) respectively (Figure 1). The revealed changes, apparently, are caused by a postoperative trauma of a thorax and incomplete recovery of respiratory muscles. In addition, these patients showed the decrease in the respiratory flow rate in the bronchi of all levels, which leads to disruption of mucociliary clearance.
Figure 1.
Dynamics of changes of spirometry parameters in patients in post-operation period after PEEP-therapy (EzPAP, USA) and vibration PEEP-therapy (Acapella, USA). * P < 0.05; ** P < 0.01; *** P < 0.001.
For example, in patients of all the studied groups a statistically significant decrease of PFER was detected, AFER 25 - 75, MFER 25, MFER 50, MFER 75. Studied parameters between groups also did not differ. All these changes are the pathogenetic basis for the development of pneumonia in the early postoperative period.
Thus, the second day post-surgery is characterized by the same decrease in volume and velocity in respiratory flow rates in all studied groups.
The fifth postoperative day is characterized by an improvement in volumetric values in group II, whereas in groups I and III they remained lower compared to the pre-surgery level. For example, in the second group vital capacity and forced vital capacity reached pre-surgery level, while in the group I these parameters decreased by 31% and 34%, and in group III - by 25% and 26% respectively. Similar changes in studied groups are detected when studying PFER, MFER 25, MFER 50.
On the ninth day after surgery vital capacity and forced vital capacity in groups II and III reach pre-surgery level, while in group I these values remain decreased by 28% and 32% respectively. Other type of changes was observed when studying velocity parameters of respiratory flow. For example, in group II PFER and AFER25-75 reach the pre-surgery level, while in groups I and III only recovery of AFER25-75 is noted. Thus, at the time of discharge from the hospital, the patients of group II recovered the volumetric and velocity values of the respiratory flow, whereas in group III only volumetric values were restored, and in group I patients there was no recovery.
In group II patients, spirometry parameters of respiratory flow were restored more quickly than in group III. So, on the fifth postoperative day, VC and FEV1 in group II were more by 25% and 33%. Similar statistically significant increases of velocity parameters of the flow (PFEV, AFEV25-75, MFEV25, MFEV50) are detected in patients of group II compared to group III.
It should be emphasized that obstructive episodes of apnea and hypopnea during sleep after surgery are accompanied by the development of hypoxemia, hemodynamic disorders, which increases the risk of sudden cardiac death. In this connection, the dynamics of night pulse oximetry parameters were studied, which allows us to evaluate episodes of hypoxemia. Analysis of the results of the desaturation index (DI) showed that the second postoperative day is characterized by pronounced sleep breathing disorders at night in all the groups studied. Thus, in groups I, II and III, the DI significantly increases 3.4, 2.6 and 2.9 folds respectively. At the same time in all groups mean SpO2 value during sleep is 90%. On the fifth postoperative day, the same values of nocturnal pulse oximetry remain in group I, whereas in groups II and III the DI decreases by 42% and 34%, respectively, which indicates a faster recovery of the respiratory function with incentive spirometry. On the ninth day after surgery ID in groups II and III reach pre-surgery level, while in the group I these values remain increased by 1.82 fold (P < 0.01). Thus, incentive spirometry allows you to recover at the time of discharge, not only postoperative volumetric and velocity respiratory values, but also to recover from sleep respiratory disorders.
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