Effect of respiratory training apparatus and vibration expectoration vest on expectoration in patients with lung cancer resection

Patients undergoing pulmonary lobectomy for tracheal catheterization under general anesthesia and endotracheal intubation may cause physical stimulation to the airway, airway secretion induced by.¹ Because of postoperative wound pain, the patients dare not force cough, leading to sputum accumulation in the respiratory tract, which easily leads to respiratory complications.² At present, the main sputum expectoration methods in the clinical operation include percussion back, acupressure stimulation, mechanical vibration expectoration vest, and respiratory training device with expectoration function as the phlegm elimination program for interventional intervention. In order to explore the advantageous expectoration scheme, the author tried to compare the effect of the sputum elimination program with the respiratory training device and the vibration expectoration vest as the representative of the vibration expectoration program, so as to provide references for clinical nursingand related research. The study was approved by the independent ethics committee of the hospital. The subjects gave informed consent and volunteered to participate in this study.

The most effective treatment for patients with early-stage lung cancer is resection of the tumor.³ However, lung surgery can destroy the thoracic organs to some extent, leading to pulmonary inflammatory exudation, weakening of the lung compliance of patients, thereby reducing the lung function of patients. However, the decline in lung function and the function of oxygen will induce cell hypoxia, so as to produce more viscous tracheal secretion and sputum, not easy to cough up, and if no timely treatment is given, it will cause further deterioration and lead to the occurrence of heart failure and respiratory failure and other adverse events. Therefore, to help patients understand the importance of expectoration and grasp the correct and effective method of expectoration in the perioperative period, make them consciously practice the corresponding expectoration program, accelerate the excretion of sputum, and become an important means to improve the effect of postoperative sputum elimination. In this study, the author analyzed the sputum excretion effect and patient experience of two different expectoration methods, in order to accumulate evidence-based data and lay the data support for patients to better deal with surgery.

The results of this study showed that the patients in the observation group have the shorter time of first sputum discharge than the control group, and the difference was statistically significant (P<0.001), suggesting that the perioperative period use by breathing trainer with sputum expectoration function can significantly reduce the first time of postoperative sputum discharge. Its role is to enable additional air into the airway secretions, reaching the bottom, through the vibration to drive the air in the airway, loosen secretions, so as to improve the effectiveness of cough, expectoration, and promote secretions off.⁴, ⁵, ⁶ Lung surgery cause a great trauma to the tissue, which causes a strong spasm of the bronchus and induces a large number of airway secretions to stay in the trachea, resulting in a decrease in the effective ventilation volume. Breathing trainer as a campaign tool can make the patients achieve power balance between pulmonary ventilation and pulmonary ventilation and then can start the inspiratory-related muscles of patients with all relevant muscles, breath and respiratory muscle coordination movement, so as to improve the tolerance of respiratory muscle activity, the alveolar expansion, improve the individual ventilation/perfusion ratio, reduce hypoxia and the incidence of hyperlipidemia, and promote aerobic metabolism of cells.⁷, ⁸, ⁹ When the patient’s pulmonary function has been improved, it can help patients to gradually transit from the shallow to slow breathing state to the rapid breathing state and avoid the status of airflow accumulation caused by slow breathing state, thus promoting secretion discharge. Through the early removal of tracheal secretions, bronchial secretion retention status of patients can be effectively alleviated, peripheral alveolar collapse status has been restored, and they are not prone to atelectasis. The risk of lung complications is also lower.¹⁰, ¹¹ In this study, the incidence of atelectasis and pulmonary infection in the observation group was significantly lower than that in the control group (P<0.05), which also fully confirmed this view.

Some studies have pointed out that postoperative incision pain is also the main reason why the patient cannot forwardly and effectively remove respiratory tract secretions.² Postoperative lung cancer patients due to disease, trauma, infection, nervous system disease, dehydration, activity limitation, as a result of anesthesia for airway mucociliary movement, reduce the thick sputum, cough, weakness, cough reflex weakens lung tissue elasticity,¹² at the same time, postoperative wound pain can cause skeletal muscle nervous reflex, causing patients fear of deep breathing, respiratory function exercise compliance decreased,¹³ leading to pulmonary insufficiency, pain can also limit the patient’s body posture change, the airway secretions cannot be discharged effectively and timely, increase the chance of pulmonary infection.¹⁴ In order to reduce postoperative pain, postoperative patients of Department of Thoracic Surgery within 12 hours start the routine use of analgesic drugs. In order to avoid the interference of pain score, in this study, the author compares the expectoration training of two groups of patients with postoperative 24-hour pain score, the observation group pain score was significantly lower than that of control group, and the difference was statistically significant (P<0.05).

Upon comparing the patients’ prognosis-related indicators of two groups, the results showed that the postoperative hospital stay of the observation group was shorter than the control group (P<0.05); respiratory-related adverse event rates after operation were lower than the control group (P<0.05, P<0.05), which can save the patient’s medical costs, reduce the economic burden to relief the mind of patients to deal with the disease, and will help to a good mental state and the overall prognosis of the disease.¹⁵, ¹⁶ With the use of breathing trainer as a tool for expectoration training and later treatment of respiratory function training program, it can fully mobilize the motivation of patients’ independent practice, so as to strengthen the subjective initiative of learning and achieve the purpose and effect of strengthening training.

For patients with lung cancer resection, the introduction of sputum breathing function training device as an interventional tool during perioperative period can promote sputum excretion, accelerate the drainage of postoperative sputum, reduce the incidence of postoperative respiratory complications, relieve pain, and promote rehabilitation. In this study, limited manpower resulted in the limitations in design and implementation of this study, which caused some problems, specifically in the following aspects: (1) only the short-term effects of the two groups were recorded and analyzed, and the long-term effects were not followed up, and hence in the follow-up study, the observation time needs to be extended, in order to understand the long-term effect;(2) We should carry out various forms of health education preoperatively, to improve patients’ understanding of the importance of respiratory function exercise before and after surgery, and the ongoing quality control in the course of the experiment is to ensure good patient compliance; (3) We did not analyze the gender and age of patients in any group, and the results are more general; and (4) The pulmonary rehabilitation and pulmonary function tests in postoperative patients should pay attention to breathing and tolerance.