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Rolul reabilitarii respiratorii in chirurgia toracica

Alina Croitoru, Daniela Jipa, Ciprian Bolca, Irina Pele, Miron Bogdan
Universitatea de Medicina si Farmacie Carol Davila, Institutul de Pneumoftiziologie
Marius Nasta, Bucuresti

Reabilitarea respiratorie reprezinta un abord terapeutic modern al bolilor


pulmonare, complementar terapiei medicamentoase, care se adreseaza oricarui bolnav cu
afectarea calitatii vietii.
Scopul principal este ameliorarea independentei functionale și autonomizarea
rapidă a pacientului. Beneficiile reabilitarii sunt: cresterea capacitatii de exercitiu,
diminuarea senzatiei de dispnee, ameliorarea calitatii vietii, reducerea numarului de zile
de spitalizare. Programele de reabilitare se pot desfaşura in sistem intraspitalicesc,
ambulator sau la domiciliu.
Unul dintre domeniile de interes ale reabilitării respiratorii este chirurgia toracica,
atat în perioada preoperatorie cat si in perioada postoperatorie. Pacientii care au risc
operator crescut (BPOC, insuficienta respiratorie) pot beneficia de reabilitare in scopul
reducerii riscului chirurgical.
Principalele componente ale reabilitarii perioperatorii sunt: drenajul bronsic,
antrenamentul muschilor respiratori, educarea respiratiei, educarea tusei, spirometria
incitativa, mobilizarea precoce, antreanamentul la efort.
Toate aceste masuri au rezultate pozitive atat in ceea ce priveste reducerea
complicatiilor postoperatorii (atelectazie, pneumonie, empiem si tromboza venoasa
profunda) si duratei spitalizarii, cat si in prevenirea scaderii volumelor pulmonare post
operatorii.
Durata reabilitarii preoperatorii este de cele mai multe ori influentata de timpul de
asteptare chirurgical, iar cea a reabilitarii postoperatorii poate varia de la 2 la 8 saptamani
(initial in spital si ulterior la domiciliu sau ambulatoriu).
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Cuvinte cheie: reabilitare respiratorie, chirurgie toracica, exercitiu

The role of respiratory rehabilitation in thoracic surgery

Alina Croitoru, Daniela Jipa, Ciprian Bolca, Irina Pele, Miron Bogdan
Carol Davila University of Medicine and Pharmacy, Marius Nasta Institute of
Pneumophtysiology Bucharest

Respiratory rehabilitation is a modern therapeutic approach for pulmonary


diseases, complementary to drug therapy, targeting any patient whose quality of life is
affected.
The primary goal is to improve functional independence and to make the patient
be autonomous quickly. Benefits of rehabilitation are: increased exercise capacity,
diminished dyspnoea sensation, improved quality of life, reduced number of
hospitalization days. Rehabilitation programs can be run in-hospital, outpatient or home-
based.
One of the areas of interest in respiratory rehabilitation is thoracic surgery, both in
the preoperative and postoperative period. Patients at increased operator risk (COPD,
respiratory failure) can benefit from rehabilitation to reduce surgical risk.
The main components of perioperative rehabilitation are: bronchial drainage,
respiratory muscles training, breathing and coughing education, incentive spirometry,
early mobilization, exercise training.
All these measures have had positive results both in reducing postoperative
complications (atelectasis, pneumonia, empyema and deep venous thrombosis) and
hospitalization duration, as well as in the prevention of postoperative reduction of
pulmonary volume.
The duration of preoperative rehabilitation is most often influenced by surgical
waiting time, and postoperative rehabilitation may vary from 2 to 8 weeks (initially in the
hospital and later at home or outpatient).
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Key words: respiratory rehabilitation, thoracic surgery, exercise