Efeitos do treinamento muscular inspiratório pré-operatório na força muscular respiratória e na função pulmonar em pacientes submetidos à correção cirúrgica de valvopatias
Arquivos
Data
2010
Autores
Barros, Cassia Fabiane de 
Orientadores
Vidotto, Milena Carlos
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: As cardiopatias valvares, ou simplesmente valvopatias, são condições
de apresentação clínica bastante variável. Muitos pacientes apresentam-se
assintomáticos por décadas, enquanto outros exibem sintomas de insuficiência
cardíaca, justificando as intervenções cirúrgicas. Quando submetidos à cirurgia
cardíaca estão sujeitos a complicações pulmonares pós-operatórias devido às
alterações da mecânica ventilatória causadas pelo procedimento cirúrgico. O
objetivo deste estudo foi avaliar os efeitos de um programa de treinamento muscular
inspiratório realizado no pré-operatório. Materiais e Métodos: A amostra foi
composta por pacientes da Enfermaria de Cirurgia Cardiovascular do Hospital da
Santa Casa da Misericórdia de Santos, que eram candidatos à cirurgia de correção
valvar. Estes foram avaliados prospectivamente e incluídos no estudo mediante os
critérios de inclusão e exclusão. Todos os pacientes foram submetidos à avaliação
inicial composta por avaliação da função pulmonar, da força muscular respiratória,
da composição corporal, do nível de atividade física habitual e da qualidade de vida.
Os pacientes foram submetidos ao programa de treinamento muscular inspiratório
(TMI) no pré-operatório.Sendo realizado durante o período de internação que
precede a cirurgia, diariamente, com duração de trinta minutos, e intensidade de
40% da pressão inspiratória máxima (Pimax), graduada em um aparelho
denominado Threshold® IMT. O treinamento foi realizado na enfermaria do hospital,
semanalmente foi reavaliada a PImax e reajustada a carga de treinamento. Os
pacientes foram reavaliados no dia anterior à cirurgia quanto força muscular
respiratória. Após o processo cirúrgico, foram reavaliados quanto função pulmonar e
força muscular respiratória e, coletados dados sobre a duração da ventilação
mecânica, a presença de complicações cardiovasculares e complicações
pulmonares, tempo de internação na unidade de terapia intensiva (UTI) e enfermaria
e óbito. Resultados: Foram avaliados oito pacientes com média de idade
39,5(±15,9), igualmente distribuído quanto ao sexo. Na avaliação inicial 50% dos
pacientes apresentaram valores de capacidade vital forçada (CVF) e volume
expiratório forçado no primeiro segundo (VEF1) abaixo do valor previsto, todos os
pacientes apresentaram valores abaixo do previsto para Pimax. Os pacientes
submetidos ao TMI durante o período de internação pré-operatório apresentaram
aumento significante (p<0,05) da PImax após o período de treinamento. Não houve
diferença significante da função pulmonar e da força de músculos respiratórios
quando comparado o pré-operatório e o pós-operatório. Conclusões: Os pacientes
valvopatas desse estudo demonstraram características de doentes restritivos quanto
à função pulmonar, força muscular inspiratória abaixo do predito, baixa qualidade de
vida quanto à limitação por aspecto físico e capacidade funcional, e sedentarismo.
Após a realização de um programa de treinamento muscular inspiratório foi
observado aumento significante de Pressão Inspiratória Máxima, e uma tendência a
não queda significante nos valores de função pulmonar e força muscular respiratória
no pós-operatório
Introduction: The heart valve or just valve diseases, conditions are highly variable clinical presentation. Many patients are asymptomatic for decades, while others exhibit symptoms of heart failure, explaining the surgery. When undergoing cardiac surgery, are subject to postoperative pulmonary complications due to changes in mechanical ventilation caused by the surgical procedure. The aim of this study was to evaluate the impact of a program of inspiratory muscle training performed preoperatively in the incidence of postoperative pulmonary complications, length of hospitalization, and quality of life. Materials and Methods: The sample consisted of patients in the Cardiovascular Surgery, Hospital Santa Casa da Misericordia de Santos, who were candidates for surgical valve repair. They were evaluated prospectively and included in the study by the criteria of inclusion and exclusion. All patients underwent initial evaluation consisting of pulmonary function, respiratory muscle strength, body composition, level of physical activity and quality of life. The patients underwent to a program of inspiratory muscle training (IMT) in the preoperative. Being performed during the hospitalization period preceding the surgery, daily, lasting thirty minutes, and intensity of 40% of maximal inspiratory pressure (MIP) graduated on an apparatus called Threshold ® IMT. The training was conducted in the hospital ward, was reviewed weekly and adjusted MIP training load. The patients were assessed the day before surgery and respiratory muscle strength. After the surgical process, were reevaluated pulmonary function and respiratory muscle strength, and collected data on the duration of mechanical ventilation, the presence of cardiovascular and pulmonary complications, length of stay in intensive care unit (ICU) and ward and died. Results: We studied eight patients with a mean age of 39.5 (± 15.9), equally distributed by gender. At the first evaluation 50% of patients had values of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) below the predicted value, all patients had values below the forecast for MIP. Patients undergoing IMR during the period of preoperative hospitalization showed significantly higher (p <0.05) MIP after the training period. There was no significant difference in lung function and expiratory muscle strength at preoperative when compared to postoperative. Conclusions: Patients with heart valve disease in our study demonstrated the characteristics of patients and restrictive pulmonary function, muscle strength below the predicted lower quality of life for the limitation of the physical and functional capacity, and physical inactivity. After carrying out a program of inspiratory muscle training was observed significant increase in maximal inspiratory pressure, and suggesting a lower probability decrease in pulmonary function and respiratory muscle strength postoperatively
Introduction: The heart valve or just valve diseases, conditions are highly variable clinical presentation. Many patients are asymptomatic for decades, while others exhibit symptoms of heart failure, explaining the surgery. When undergoing cardiac surgery, are subject to postoperative pulmonary complications due to changes in mechanical ventilation caused by the surgical procedure. The aim of this study was to evaluate the impact of a program of inspiratory muscle training performed preoperatively in the incidence of postoperative pulmonary complications, length of hospitalization, and quality of life. Materials and Methods: The sample consisted of patients in the Cardiovascular Surgery, Hospital Santa Casa da Misericordia de Santos, who were candidates for surgical valve repair. They were evaluated prospectively and included in the study by the criteria of inclusion and exclusion. All patients underwent initial evaluation consisting of pulmonary function, respiratory muscle strength, body composition, level of physical activity and quality of life. The patients underwent to a program of inspiratory muscle training (IMT) in the preoperative. Being performed during the hospitalization period preceding the surgery, daily, lasting thirty minutes, and intensity of 40% of maximal inspiratory pressure (MIP) graduated on an apparatus called Threshold ® IMT. The training was conducted in the hospital ward, was reviewed weekly and adjusted MIP training load. The patients were assessed the day before surgery and respiratory muscle strength. After the surgical process, were reevaluated pulmonary function and respiratory muscle strength, and collected data on the duration of mechanical ventilation, the presence of cardiovascular and pulmonary complications, length of stay in intensive care unit (ICU) and ward and died. Results: We studied eight patients with a mean age of 39.5 (± 15.9), equally distributed by gender. At the first evaluation 50% of patients had values of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) below the predicted value, all patients had values below the forecast for MIP. Patients undergoing IMR during the period of preoperative hospitalization showed significantly higher (p <0.05) MIP after the training period. There was no significant difference in lung function and expiratory muscle strength at preoperative when compared to postoperative. Conclusions: Patients with heart valve disease in our study demonstrated the characteristics of patients and restrictive pulmonary function, muscle strength below the predicted lower quality of life for the limitation of the physical and functional capacity, and physical inactivity. After carrying out a program of inspiratory muscle training was observed significant increase in maximal inspiratory pressure, and suggesting a lower probability decrease in pulmonary function and respiratory muscle strength postoperatively
Descrição
Citação
BARROS, Cassia Fabiane de. Efeitos do treinamento muscular inspiratório pré-operatório na força muscular respiratória e na função pulmonar em pacientes submetidos à correção cirúrgica de valvopatias. 2010. 49 f. Trabalho de conclusão de curso de graduação (Fisioterapia) - Instituto de Saúde e Sociedade (ISS), Universidade Federal de São Paulo (UNIFESP), Santos, 2010.