术前肺康复训练在心脏外科手术患者中应用的范围综述

doi:10.3761/j.issn.0254-1769.2025.02.006

摘要/Abstract

摘要：

目的对心脏外科手术患者术前肺康复训练的相关研究进行范围综述，为构建适合国内患者的术前肺部预康复护理方案提供循证支持。方法以澳大利亚乔安娜布里格斯研究所范围综述指南为指导，计算机检索PubMed、Embase、Web of Science、CINAHL、中国知网和万方数据库中的相关文献，检索时限为建库至2024年6月。对纳入文献进行系统分析。结果共纳入26篇文献，4篇为类实验研究，22篇为随机对照研究。心脏外科术前肺康复训练形式包括综合性呼吸功能锻炼、吸气肌训练、呼气阻力训练、激励式肺活量计训练及吹气球训练;干预开始时间从术前10周到术前1天;结局指标包括术后肺部并发症、肺功能、6 min步行试验、机械通气时长、住院时长、患者自我报告结局等。结论心脏外科手术患者术前肺康复训练尚缺乏统一标准，未来应开展高质量研究，优化心脏外科手术患者肺部预康复干预策略并建立统一的评价标准。

关键词: 心脏外科, 肺康复, 范围综述, 围手术期护理

Abstract:

Objective A scoping review of studies on pulmonary prehabilitation in cardiac surgery patients was conducted to provide evidence support for the construction of a preoperative pulmonary rehabilitation program for cardiac surgery patients that suitable for China’s national conditions. Methods In accordance with the scope review’s research methodologies，databases including PubMed，Embase，Web of Science，CINAHL，CNKI and Wanfang were searched by the computer for relevant studies. The deadline for retrieval is from the establishment of databases to June，2024. The included literature was systematically analyzed. Results 26 articles were finally included. Among them，4 were quasi-experiment studies，while the other 22 were randomized controlled trials. Forms of the intervention included comprehensive breathing exercises，inspiratory muscle training，positive expiratory pressure，incentive spirometer training and balloon blowing training. The intervention initiation ranged from 10 weeks to 1 day preoperatively;the outcome measures included postoperative pulmonary complications，lung function metrics，the 6-Minute Walk Test，duration of mechanical ventilation，length of hospital stay，patient-reported outcomes and so on. Conclusion There remains a deficiency in standardized protocols for preoperative pulmonary rehabilitation training among patients undergoing cardiac surgery. High-quality studies should be conducted，and intervention strategies for pulmonary prehabilitation in cardiac surgery patients should be optimized and a unified evaluation standard system should be established.

Key words: Cardiac Surgery, Pulmonary Rehabilitation, Scoping Review, Perioperative Nursing

黄莉, 刘雅戈, 张玢, 赵瑾, 白云锋, 耿倩, 罗红波, 赵明曦, 张路, 曹晶. 术前肺康复训练在心脏外科手术患者中应用的范围综述[J]. 中华护理杂志, 2025, 60(2): 162-169.

HUANG Li, LIU Yage, ZHANG Bin, ZHAO Jin, BAI Yunfeng, GENG Qian, LUO Hongbo, ZHAO Mingxi, ZHANG Lu, CAO Jing. Application of preoperative pulmonary rehabilitation training in patients undergoing cardiac surgery：a scoping review[J]. Chinese Journal of Nursing, 2025, 60(2): 162-169.

图/表 2

参考文献 37

[1]	中国生物医学工程学会体外循环分会. 2023年中国心血管外科手术和体外循环数据白皮书[J]. 中国体外循环杂志, 2024, 22(4):259-262.
	Chinese Society of Extracorporeal Circulation. White book of Chinese cardiovascular surgery and extracorporeal circulation in 2023[J]. Chin J Extracorpor Circ, 2024, 22(4):259-262.
[2]	陈媛儿, 何晓娣, 宋剑平, 等. 心脏外科手术患者术前呼吸功能优化策略的最佳证据总结[J]. 护理学杂志, 2021, 36(19):43-47.
	Chen YE, He XD, Song JP, et al. Evidence summary on preoperative respiratory optimization in patients to receive cardiac surgery[J]. J Nurs Sci, 2021, 36(19):43-47.
[3]	范光磊, 马广宇, 徐蔚, 等. 术前衰弱对老年患者心脏手术后肺部并发症的预测价值[J]. 临床麻醉学杂志, 2023, 39(12):1255-1259.
	Fan GL, Ma GY, Xu W, et al. Predictive value of preoperative frailty for pulmonary complications after cardiac surgery in elderly patients[J]. J Clin Anesthesiol, 2023, 39(12):1255-1259.
[4]	Nery RM, Barbisan JN. Effect of leisure-time physical activity on the prognosis of coronary artery bypass graft surgery[J]. Rev Bras Cir Cardiovasc, 2010, 25(1):73-78.
[5]	李沪生, 吴静, 李枘瑾, 等. 预康复对心外科择期手术患者术后恢复影响的Meta分析[J]. 中华现代护理杂志, 2022, 28(6):707-714.
	Li HS, Wu J, Li RJ, et al. Effects of pre-rehabilitation on postoperative recovery of patients undergoing elective cardiac surgery:a Meta-analysis[J]. Chin J Mod Nurs, 2022, 28(6):707-714.
[6]	Moradian ST, Heydari AA, Mahmoudi H. What is the role of preoperative breathing exercises in reducing postoperative atelectasis after CABG?[J]. Rev Recent Clin Trials, 2019, 14(4):275-279. DOI PMID
[7]	Valkenet K, Trappenburg JCA, Hulzebos EH, et al. Effects of a pre-operative home-based inspiratory muscle training programme on perceived health-related quality of life in patients undergoing coronary artery bypass graft surgery[J]. Physiotherapy, 2017, 103(3):276-282. DOI PMID
[8]	Furon Y, van SD, Blanchard S, et al. Effects of high-intensity inspiratory muscle training on systemic inflammatory response in cardiac surgery:a randomized clinical trial[J]. Physiother Theory Pract, 2024, 40(4):778-788.
[9]	Chen XY, Hou L, Zhang YY, et al. The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery:a randomized controlled trial[J]. Clin Rehabil, 2019, 33(5):913-922.
[10]	Akowuah EF, Wagnild JM, Bardgett M, et al. A randomised con-trolled trial of prehabilitation in patients undergoing elective cardiac surgery[J]. Anaesthesia, 2023, 78(9):1120-1128. DOI PMID
[11]	Sahar W, Ajaz N, Haider Z, et al. Effectiveness of pre-operative respiratory muscle training versus conventional treatment for improving post operative pulmonary health after coronary artery bypass grafting[J]. Pak J Med Sci, 2020, 36(6):1216-1219. DOI PMID
[12]	Sobrinho MT, Guirado GN, Silva MA. Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization[J]. Rev Bras Cir Cardiovasc, 2014, 29(2):221-228.
[13]	Hulzebos EH, Helders PJ, Favié NJ, et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery:a randomized clinical trial[J]. JAMA, 2006, 296(15):1851-1857. DOI PMID
[14]	Shahood H, Pakai A, Rudolf K, et al. The effect of preoperative chest physiotherapy on oxygenation and lung function in cardiac surgery patients:a randomized controlled study[J]. Ann Saudi Med, 2022, 42(1):8-16. DOI PMID
[15]	Sweity EM, Alkaissi AA, Othman W, et al. Preoperative incentive spirometry for preventing postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery:a prospective,randomized controlled trial[J]. J Cardiothorac Surg, 2021, 24, 16(1):241
[16]	Nejkov S, Bokan-Mirkovi V, Ðukić-Macut N, et al. Effect of preoperative respiratory rehabilitation in patients undergoing cardiac surgery[J]. Acta Clin Croat, 2020, 59(4):597-604. DOI PMID
[17]	Shakouri SK, Salekzamani Y, Taghizadieh A, et al. Effect of respiratory rehabilitation before open cardiac surgery on respiratory function:a randomized clinical trial[J]. J Cardiovasc Thorac Res, 2015, 7(1):13-17. DOI PMID
[18]	Ibrar I, Shabbir S, Ahmad H, et al. Effects of pre-surgical education and physical therapy training for dyspnea prevention in patients undergoing valvular cardiac surgery[J]. Pak J Med Health Sci, 2022, 16(2):518-520.
[19]	Ferreira PEG, Rodrigues AJ, Evora PRB. Effects of an inspiratory muscle rehabilitation program in the postoperative period of cardiac surgery[J]. Arq Bras Cardiol, 2009, 92(4):275-282. DOI PMID
[20]	Talib AR, Hamza RA, Mahbuba WA. Effectiveness of preoperative breathing exercises on postoperative lung function outcomes for patients with cardiac surgery[J]. Curr Probl Cardiol, 2024, 49(11):102784.
[21]	费俊杰, 陈剑, 陈杰, 等. 术前综合呼吸锻炼对体外循环心脏手术病人术后呼吸功能及肺部并发症的影响[J]. 中西医结合心脑血管病杂志, 2023, 21(22):4203-4206.
	Fei JJ, Chen J, Chen J, et al. Effect of preoperative comprehensive respiratory exercise on postoperative respiratory function and pulmonary complications of patients undergoing cardiac surgery under cardiopulmonary bypass[J]. Chin J Integr Med Cardio Cerebrovasc Dis, 2023, 21(22):4203-4206.
[22]	丁艳琼, 王建荣, 于亚群. 术前呼气阻力训练对体外循环冠状动脉旁路移植术患者围术期肺功能的影响[J]. 中国体外循环杂志, 2017, 15(2):96-99.
	Ding YQ, Wang JR, Yu YQ. Effects of preoperative positive expiratory pressure breathing exercises on peri-operative pulmonary function in patients undergoing coronary artery bypass graft[J]. Chin J Extracorpor Circ, 2017, 15(2):96-99.
[23]	许志锋, 吴桂琴, 吴永前, 等. 术前呼吸肌训练对心脏瓣膜置换术吸气肌无力患者预后的影响[J]. 岭南心血管病杂志, 2023, 29(4):380-384.
	Xu ZF, Wu GQ, Wu YQ, et al. Effect of preoperative inspiratory muscle training on postoperative recovery in inspiratory muscle weakness patients referred for cardiac valve replacement[J]. South China J Cardiovasc Dis, 2023, 29(4):380-384.
[24]	孙党红, 孙丽, 姚燕, 等. 吹气球呼吸功能训练对心脏围术期患者术前呼吸功能的影响[J]. 实用临床医药杂志, 2014, 18(6):75-76,79.
	Sun DH, Sun L, Yao Y, et al. Effect of respiratory function training of balloon-blowing mode on preoperative respiratory function in patients undergoing cardiac surgery[J]. J Clin Med Pract, 2014, 18(6):75-76,79.
[25]	王芳, 曹苗苗, 苏珍珍, 等. 术前呼吸功能锻炼对老年患者瓣膜置换术后肺功能的影响[J]. 中国体外循环杂志, 2022, 20(5):308-311.
	Wang F, Cao MM, Su ZZ, et al. Effect of preoperative respiratory function exercise on postoperative pulmonary function in elderly patients with valve replacement[J]. Chin J Extracorpor Circ, 2022, 20(5):308-311.
[26]	郑慧萍, 鲁胜男, 张喆. 术前呼吸肌训练对吸气肌无力者冠状动脉旁路移植术预后的影响[J]. 临床心血管病杂志, 2018, 34(3):272-275.
	Zheng HP, Lu SN, Zhang Z. Effect of preoperative inspiratory muscle training on postoperative recovery in inspiratory muscle weakness patients referred for coronary artery bypass grafting[J]. China Ind Econ, 2018, 34(3):272-275.
[27]	赵铁夫, 王盛宇, 马涵英, 等. 术前呼吸训练对行不停跳冠状动脉旁路移植术患者围术期呼吸系统并发症的影响研究[J]. 中国全科医学, 2015, 18(10):1161-1164. DOI
	Zhao TF, Wang SY, Ma HY, et al. Effect of preoperative respiratory training on perioperative complications of respiratory system in patients undergoing off-pump coronary artery bypass grafting[J]. Chin Gen Pract, 2015, 18(10):1161-1164.
[28]	王其燕, 王媚媚, 王妍珂, 等. 术前应用呼吸训练器对风心瓣膜置换术后肺功能和血气指标的影响[J]. 中国临床新医学, 2018, 11(12):1264-1266.
	Wang QY, Wang MM, Wang YK, et al. Effect of preoperative respiratory trainer on pulmonary function and blood gas index after rheumatic heart valve replacement[J]. Chin J N Clin Med, 2018, 11(12):1264-1266.
[29]	陈英. 术前综合干预对冠状动脉旁路移植术患者术后呼吸功能的影响[J]. 现代医药卫生, 2016, 32(7):1088-1089.
	Chen Y. Effect of preoperative comprehensive intervention on postoperative respiratory function on patients undergoing coronary artery bypass grafting[J]. J Mod Med & Health, 2016, 32(7):1088-1089.
[30]	钟宇红, 廖旭嘉. 心脏手术前使用呼吸训练器的护理干预[J]. 医学理论与实践, 2019, 32(14):2294-2295.
	Zhong YH, Liao XJ. Nursing intervention of using respiratory trainer before cardiac surgery[J]. J Med Theory and Pract, 2019, 32(14):2294-2295.
[31]	罗泽汝心, 王渝强, 周亚馨, 等. 有限资源下创新性吸气肌训练方案对心脏瓣膜疾病患者术后肺部并发症的影响[J]. 中国康复医学杂志, 2024, 39(1):39-44,69.
	Luo ZRX, Wang YQ, Zhou YX, et al. Effects of an innovative inspiratory muscle training program on postoperative pulmonary complications in patients with valvular heart disease with limited resources[J]. Chin J Rehab Med, 2024, 39(1):39-44,69.
[32]	姚丽, 杨琳, 杨丽平, 等. 机械通气患者吸气肌训练效果的Meta分析[J]. 中华护理杂志, 2020, 55(1):141-147. DOI URL
	Yao L, Yang L, Yang LP, et al. Inspiratory muscle training in patients with mechanical ventilation:a meta-analysis[J]. Chin J Nurs, 2020, 55(1):141-147.
[33]	曾玉婷, 李芳, 时刘敏, 等. 老年患者术后肺部并发症早期识别及护理干预研究进展[J]. 中华护理杂志, 2019, 54(7):1102-1107. DOI URL
	Zeng YT, Li F, Shi LM, et al. Research progress on early recognition and nursing intervention of postoperative pulmonary complications in elderly patients[J]. Chin J Nurs, 2019, 54(7):1102-1107.
[34]	高墨涵, 钱星星, 王若冰, 等. 心脏外科术后患者出院前6分钟步行试验结果及影响因素分析[J]. 中华护理杂志, 2018, 53(4):428-432.
	Gao MH, Qian XX, Wang RB, et al. Six-minute walk distance and its influencing factors in patients underwent cardiac surgery before discharge[J]. Chin J Nurs, 2018, 53(4):428-432.
[35]	Kendall F, Oliveira J, Peleteiro B, et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay:a systematic review and meta-analysis[J]. Disabil Rehabil, 2018, 40(8):864-882. DOI PMID
[36]	刘子嘉, 张路, 刘洪生, 等. 基于加速术后康复的胸外科手术预康复管理专家共识(2022)[J]. 协和医学杂志, 2022, 13(3):387-401.
	Liu ZJ, Zhang L, Liu HS, et al. Expert consensus on prehabilita-tion management for enhanced recovery in patients undergoing thoracic surgery(2022)[J]. Med J Peking Union Med Coll Hosp, 2022, 13(3):387-401.
[37]	Bissett B, Leditschke IA, Green M, et al. Inspiratory muscle training for intensive care patients:a multidisciplinary practical guide for clinicians[J]. Aust Crit Care, 2019, 32(3):249-255. DOI PMID