Exercise machine for breathing exercises after surgery. Complex of therapeutic exercises after surgery. Contraindications to the appointment of exercise therapy

News

ANNOUNCEMENT!!!

In GBUZ OD No. 2 from July 08, 2019 to July 22, 2019, removal and consultation about moles will not be carried out.

Open Day

May 25, Saturday, from 09:00 to 13:00, an open day was held, which combined two actions at once - the day of the fight against melanoma and the day of women's health.

positive developments

The facade of the department was renovated with modern materials that are resistant to the effects of the external environment and have an excellent aesthetic appearance, which indirectly affected the strengthening of labor discipline and increased labor productivity.

Positive ultrasound event

A biopsy nozzle for the intracavitary sensor of the Toshiba aplio 500 expert-class ultrasound scanner was purchased for the ultrasound diagnostic room of the State Budgetary Healthcare Institution No. 2 of the Ministry of Health of the Kyrgyz Republic for multifocal transrectal biopsy of the prostate.

Open Day

On March 2, 2019, the Oncological Dispensary No. 2 of the Ministry of Health of the KK hosted an open day dedicated to women's health, timed to coincide with International Women's Day on March 8.

Open Day

On February 2, 2019, at the Oncological Dispensary No. 2 of the Ministry of Health of the KK, an "Open Day dedicated to men's and women's health" was held.

Staff training

Employees of the GBUZ "Oncological Dispensary No. 2" were trained under the program "Training officials, specialists and the public in the field of civil defense and emergency situations."

Regional meeting

Employees of the Oncological Dispensary No. 2 took an active part in the regional meeting "Results of the work of the regional Disaster Medicine Service in 2017 and tasks for 2018".

Oleg Kit, chief oncologist of the Southern Federal District, appreciated the quality of the oncological service in the city of Sochi

On April 23, 2018, Oleg Kit, chief freelance oncologist of the Southern Federal District, head of the Rostov Oncology Institute, held a working meeting with Roman Murashko, chief oncologist of the Krasnodar Territory, and visited the Oncology Center in Sochi.

X Congress of Oncologists and Radiologists of the CIS and Eurasia

All-Russian week of labor protection

The employees of the dispensary took an active part in the All-Russian Week of Occupational Safety and Health 2018.

Open Day

In February and March 2018, regular open days were held, namely:

Open Day

On January 27, 2018, from 9-00 to 12-00, an open day was held at GBUZ OD No. 2 dedicated to the early diagnosis of breast and skin cancer.

Open Day

On October 7, 2017, from 09:00 to 12:00, an open day was held at GBUZ OD No. 2, dedicated to the early diagnosis of breast cancer.

Open Day

09/23/2017 from 9-00 to 12-00 in GBUZ OD No. 2, an open day was held dedicated to the early diagnosis of head and neck tumors.

Scientific and practical conference

The city of Sochi hosted the first annual scientific and practical conference on early diagnosis of cancer of visually observable localizations for primary care physicians in order to increase oncological alertness and increase the proportion of cancer detection in the early stages.

GBUZ OD No. 2 holding a week of men's and women's health

As part of the action of men's and women's health, oncologists were receiving.

Open Day

Open Day

On November 19, 2016, from 09:00 to 12:00, an Open Day was held dedicated to the early diagnosis of breast cancer.

Open Day

10/01/2016 from 9-00 to 12-00 in GBUZ OD No. 2 an open day was held dedicated to the early diagnosis of breast cancer.

Reminder to the patient after surgery on the lungs

Tobacco smoking must be stopped. Smoking is very harmful for anyone, but especially for those who have had lung surgery. It is not easy to get rid of nicotine addiction. And if it is impossible to give up this addiction by willpower, then you should seek help. Perhaps it will be treatment by a psychotherapist, acupuncture, coding. But the goal must be reached
In addition, you should avoid staying in a dusty and gassed atmosphere, inhaling toxic and potent substances. It is useful to install air ionizers in your home.
Large doses of alcohol depress breathing and reduce the defenses of the human body.
The amount of alcohol should be reduced to 30 ml of pure ethanol for men, to 10 ml per day for women and people with low body weight. If the patient has alcoholic damage to the liver, heart, nervous system, it is necessary to categorically refuse to drink alcoholic beverages.

Nutrition after lung surgery

To restore the body after lung surgery, nutrition should be complete, easily digestible. The food should contain vitamins, vegetables, fruits and juices.
A mandatory requirement for nutrition is the restriction of table salt. Sodium chloride intake should not exceed 6 g per day.
The patient after lung surgery should maintain a body mass index (BMI) at the level of 18.5-24.9 kg/m2. Body mass index can be calculated using the formula:

BMI = body weight / height in meters 2

It is impossible to increase body weight, and patients with overweight and obesity must necessarily bring their weight back to normal. It is very important!!! Excess body weight significantly increases the load on the lungs and heart, and therefore increases shortness of breath.
For patients who have undergone lung surgery, exercise has a special meaning. They will allow you to develop the compensatory (reserve) capabilities of the remaining lung and the cardiovascular system. The body will quickly get used to working in new conditions and the person will return to an active life earlier.
Active physical exercises should not be performed by patients with shortness of breath at rest, severe hearing and vision loss, motor disorders, as well as during an exacerbation or the onset of acute infectious diseases (flu, colds, exacerbation of bronchitis, pneumonia).
Physical training should be regular and long. The positive effect of physical exercises disappears within 3 weeks after their termination. Thus, the introduction of physical activity into the lifelong program of management of patients after lung surgery is mandatory.
Physical exercises can be performed by all patients after lung surgery without age and gender restrictions against the background of selected drug treatment.

Physical activity should be stopped:

Severe fatigue
Increased shortness of breath
Pain in the calf muscles
A sharp decrease and increase in blood pressure
Feeling the heartbeat
The appearance of chest pain
Great dizziness, noise and pain in the head.

In order to normalize the tone of the smooth muscles of the bronchi, breathing exercises are performed with the pronunciation of sounds.

1. After a moderate inhalation, on a slow exhalation, the chest is squeezed in the middle and lower sections, pronouncing the sounds “pf, prr, brroh, drohh, drahh, bruhh”. The sound “rr” should be stretched out especially long on the exhale. Exit with each sound exercise should be repeated 4-5 times, gradually increasing the number of repetitions as you train up to 7-10 times. The duration of the exhalation according to the stopwatch should be at first 4-5 seconds, gradually reaching 12-25 seconds.
2. The same exercises can be done with a towel. A towel surrounds the chest. On a slow exhalation, the ends of the towel squeeze the chest and pronounce the sounds listed above (6-10 times).
3. From the starting position, half-sitting after a moderate inhalation on a slow exhalation, alternately pulling up the legs to the abdominal and chest walls. Each exhalation is followed by a superficial breath.

After 1-2 months of regular exercises aimed at strengthening the respiratory muscles. When performing physical exercises, weights are introduced.
Relaxation is an important component of exercise.
Relaxation begins with the muscles of the legs, then successively passes to the muscles of the arms, chest, neck. Exercises to relax the muscles of the arms, legs, chest, neck are performed in a sitting and standing position. In the future, the patient's attention is fixed on the fact that the muscles. Those not participating in this exercise should be relaxed. Each procedure of therapeutic gymnastics ends with general muscle relaxation.

Medical preparations

It is very important to monitor the full expectoration of sputum. For this purpose, you can take medicinal herbs (breast collection, bogus, knotweed, etc.) and expectorant drugs under the supervision of your doctor. Some patients suffering from bronchitis with impaired bronchial patency need drugs that dilate the bronchi. This treatment should also be under the supervision of a healthcare professional.
It is very important to effectively treat existing diseases of the cardiovascular system, such as arterial hypertension, coronary heart disease, circulatory failure.
Almost all patients after lung surgery should take drugs that fit the work of the heart in the new conditions. However, advice on the selection of drugs and control over their action should be carried out by the attending physician.

How to reduce shortness of breath?

Try to stop crying. Smoking continues the irreversible aging of the remaining lung and increases the risk of heart attack and stroke.
Watch for a good expectoration of sputum.
Watch your body weight.
Reduce your salt intake to a minimum.
Get regular moderate exercise for at least 20 minutes three times a week. Suitable dosed walking, swimming, cycling.
Do not exceed the amount of alcohol per day (30 ml of pure ethanol for men, up to 10 ml per day for women and people with low body weight).
Leave time for rest every day.

When should you see a doctor without delay?

If there is a body temperature and purulent sputum is coughed up.
If there is an admixture of blood in the sputum.
If shortness of breath has increased excessively and does not decrease in the usual, previously helping ways.
If there is a sharp decrease or increase in blood pressure.
If chest pains appear or become more frequent.

INTERVENTIONS ON THE ORGANS OF THE CHEST

THERAPEUTIC PHYSICAL CULTURE IN SURGERY

Surgical treatment of chronic lung diseases (bronchiectasis, abscesses, chronic destructive tuberculosis) is used in case of their unsuccessful conservative treatment. Along with this, surgical interventions on the lungs are used for benign and malignant tumors. During the operation, a segmentectomy, lobectomy or pulmonectomy is performed.

Radical operations on the lungs cause profound changes in the body due to surgical trauma and a decrease in the respiratory surface. When a lobe of the lung is removed, and especially after pulmonectomy, new hemodynamic conditions arise due to the shutdown of part of the pulmonary circulation. A sharp increase in heart rate, shortness of breath indicate a high degree of tension of the compensatory forces of the body, aimed at reducing the phenomena of pulmonary and pulmonary heart failure. The development of compensation processes during operations on the lungs depends on the state of a healthy lung, chest excursion, the state of the central nervous system, which also suffers from respiratory circulatory disorders. Pulmonary complications - pneumonia, atelectasis - sharply worsen the condition of patients in the postoperative period, and sometimes cause deaths.

The success of radical operations on the lungs largely depends on the functional capabilities of the patient's body, on the ability to mobilize compensatory forces to overcome disorders that occur during surgery and in the postoperative period. Naturally, only drug therapy in the preoperative period cannot fully stimulate the body's compensatory capabilities and ensure the preparation of the patient for surgery. Among the measures that activate adaptive processes and increase the body's resistance in patients with lung diseases, exercise therapy plays an important role.

Exercise therapy in the postoperative period plays an even greater role. First, new conditioned reflex connections are established between the motor apparatus and the respiratory center under conditions of a remote lung or its lobe. Secondly, through the reticular formation of the brain stem, tonic effects on the cerebral cortex are carried out, which improves the general well-being, mood of the patient and contributes to a better course of the postoperative period. Thirdly, during therapeutic exercises, afferent impulses entering the central nervous system from the muscles produce tonic effects on the vasomotor and other subcortical centers, improving the supply of oxygen to the whole organism.

The main tasks of exercise therapy in the preoperative period are aimed at: reduction of purulent intoxication; increase in the functional state of the cardiovascular system; improvement of the function of external respiration; strengthening the patient's physical strength and neuropsychic status; mastering the exercises necessary for the patient in the early postoperative period.

Great importance in the period of preoperative preparation should be given to the improvement of ventilation parameters, the decrease of which may be the result of a decrease in functioning lung tissue, blockage of the main bronchus by a tumor, impaired patency of the bronchioles, or damage to the lung by a suppurative process.

Contraindications to the appointment of exercise therapy in the preoperative period are: pulmonary bleeding, accompanied by profuse hemoptysis (traces of blood in the sputum do not prevent the appointment of exercise therapy); severe cardiovascular insufficiency (stage 3), myocardial or pulmonary infarction in the acute period, high temperature (if this is not due to sputum retention).

Remedial gymnastics should be started in the first days after the patient's admission to the clinic. In the first days of classes, one should strive to reduce purulent intoxication, using exercises for this purpose that promote the outflow of sputum from the bronchiectasis cavities and abscess cavities. During this period, up to 60-70% of the total number of exercises should be aimed at improving the drainage function of the bronchial tree, increasing the outflow of sputum. Patients who secrete a large amount of sputum are recommended to perform exercises aimed at draining the bronchi up to 8-10 times a day: in the morning before breakfast for 20-25 minutes, then 2 hours after breakfast, after daytime rest, every hour before dinner and an hour before bed. The nature of drainage exercises, as well as the corresponding initial position of the patient's body during their implementation, are determined by the localization and prevalence of the suppurative process (see "Therapeutic exercise for bronchiectasis").

In the future, as the daily amount of sputum and the amount of sputum discharged during drainage exercises decrease, intoxication decreases, the general condition of the patient improves, the share of general developmental and special exercises in the procedure of therapeutic exercises increases. Special exercises are aimed at activating the reserve capabilities of the cardiorespiratory system, forming compensations, improving ventilation, increasing diaphragm mobility, teaching full inspiration, and increasing the strength of the respiratory muscles. The patient is taught deep breathing through the nose, a set of exercises for the early postoperative period. Breathing exercises of a static and dynamic nature, exercises in localized breathing, exercises for all muscle groups without objects and with objects, games are used. A significant place is given to breathing training while walking, first on level ground, and then when climbing stairs. Patients are taught to control breathing during physical activity that requires coordination. All types of load associated with the elements of effort (throw the ball, tilt the body, etc.) should be performed during exhalation.

Before pulmonectomy patients perform a set of special breathing exercises aimed at activating the reserves of a predominantly healthy lung.

Exercise therapy in the postoperative period. The tasks of exercise therapy in the early postoperative period (2-5 days after surgery) are: prevention of pulmonary complications (atelectasis, pneumonia); prevention of phlebothrombosis; maximum development of the compensatory capabilities of the lungs and the cardiovascular system; prevention of disorders of the gastrointestinal tract (paresis of the stomach and intestines, stool retention, flatulence, etc.); prevention of limited mobility in the shoulder joint on the operated side, posture disorders and chest deformity; preparation of patients for the expansion of the mode of physical activity; increased tone of the nervous system.

Contraindications to therapeutic exercises: the general serious condition of patients, due to complications during the operation (shock, cardiac arrest, large blood loss, etc.); secondary bleeding or the risk of its occurrence, frequent and small pulse with low maximum blood pressure (below 90-100 mm Hg), severe acute respiratory and cardiopulmonary failure, excluding the possibility of additional physical activity, etc. Contraindications are usually temporary.

Therapeutic exercises in the absence of complications should be started 1-2 hours after the end of anesthesia. Exercises are recommended that help the patient learn to breathe correctly faster, facilitate the separation of mucus and sputum from the respiratory tract, improve lung ventilation, help cough up sputum and induce coughing. The patient performs the exercises that were mastered by him during the preoperative preparation.

In the initial position, lying on your back, deep diaphragmatic breathing is performed. On exhalation, the exercise therapy instructor slightly presses on the upper quadrant of the abdomen closer to the operated side. At the end of expiration, the patient coughs, while one hand of the instructor is on the postoperative wound, the other on the hypochondrium of the operated side. With frequent performance of this exercise (up to 10-12 times a day), at the end of the first day, the patient can independently perform it every 30 minutes-1 hour.

Thoracic breathing is carried out with the help of an instructor: at the end of exhalation, he presses on the patient's chest synchronously with coughing shocks and achieves sputum removal. By the middle or by the end of the first day, the head end of the bed rises as much as possible (in the absence of contraindications) and the instructor conducts slow rotational movements in the patient's shoulder joint. All movements are carried out on a slow exhalation. Then the patient performs breathing exercises with coughing. After that, a light massage of the arm and the entire shoulder girdle is advisable. The load gradually increases due to an increase in the number of exercises, range of motion, change of starting positions. Classes are held 3-5 times a day.

On the 2nd day, the patient, with the help of an instructor (and then independently), turns to the healthy side (legs are pulled up to the stomach) and performs dynamic breathing exercises, alternating abdominal breathing with chest breathing. The instructor or the patient himself supports the postoperative wound with his hand, pressing the diaphragm with the other hand while exhaling. In addition, to improve the airiness of the lung tissue, it is recommended to inflate rubber or polyethylene toys and balloons 3-4 times a day. From the initial position lying on the side, it is advisable to apply a back and chest massage (especially for weakened patients) with elements of light stroking, vibration, tapping. Light tapping and vibration is carried out on exhalation and at the time of coughing. Massage promotes sputum discharge, increases the tone of the respiratory muscles. Reflex way improves ventilation. Along with this, it is recommended to massage the lower extremities, movements in the small muscle groups of the arms and legs, which improve peripheral blood circulation.

In the absence of drainage and a smooth postoperative period from the 2-3rd day, the patient's motor regimen is expanded. Rotations to the diseased side are allowed in order to activate breathing in a healthy lung, alternately pulling the legs to the stomach, “walking” lying down. All movements are necessarily combined with breathing, their loading part is performed on a slow exhalation. In order to prevent contractures in the shoulder joint on the side of the operation, the range of motion in the shoulder joint is increased. From the starting position, sitting in bed, the patient, with the help of a healthy hand, raises his hand from the affected side, moving it in the horizontal and vertical planes. Dynamic breathing exercises are carried out independently at a slow pace (exhalation with coughing). With good tolerance of this load, “walking” lying down with a full range of motion in the knee and hip joints, abduction of the upper and lower extremities (without taking them off the bed) is allowed. From the 3-4th day, it is allowed to lower the legs from the bed to the bench and perform the same set of physical exercises from this starting position.

In the absence of complications from the cardiovascular and respiratory systems, the patient can perform physical exercises in the initial position sitting on a chair. On the 6-7th day, the patient is allowed to get up for 1-2 minutes (at first with the help of an instructor), then walk around the ward and corridor. During this period, in order to further train the body, the range of motion and the number of exercises are increased, special breathing exercises and general developmental exercises from the preoperative preparation complex are included, and gymnastic items are used.

The duration of the therapeutic gymnastics procedure in the first 2-3 days is 5-10 minutes, on the 4-7th day - 10-15 minutes and in the last days of the patient's stay in the clinic - from 15 to 20 minutes.

In the first days after the operation, classes are carried out individually, then, as the body adapts to physical activity and the patient masters breathing exercises and exercises that increase the mobility of the arm on the operated side, therapeutic exercises are carried out in groups of 2-3 people. In addition to classes with an instructor, patients repeat a set of exercises on their own 3-5 times a day (in the morning before breakfast, an hour after breakfast, before dinner, after a day's rest and an hour before bedtime).

If patients secrete 50-100 ml / day of sputum, then the procedure of therapeutic exercises begins with exercises that contribute to the drainage of the bronchi. These exercises are recommended to be performed after surgery up to 5-6 times a day or more.

sick after pulmonectomy a less stressful mode of motor activity is shown than for patients after the removal of one or two lobes of the lung. Therapeutic exercises are carried out 3-5 times a day for 3-5 minutes.

In the first 2 days, therapeutic exercises should promote deep and rare breathing, better sputum discharge, increase the mobility of the diaphragm and chest of the healthy side. Along with breathing exercises, massage of the chest, lower extremities and hands on the operated side is used. It is recommended to inflate rubber toys and balloons (up to 6-8 times a day).

Starting from the 2nd day, exercises that contribute to the normalization of breathing are performed in the initial position lying on the operated side. All exercises are conducted with the help of an instructor. On the 5th-6th day after pulmonectomy, patients from the intensive care unit are transferred to the thoracic ward, where they continue individual lessons, gradually expanding the motor regimen. With the help of an instructor, a ward nurse, and then with the help of patients, the patient sits in bed for 3-5 minutes 3-5 times a day (the back rests on pillows, a bench is placed under the feet). From this position, the patient performs 4-5 exercises aimed at improving pulmonary ventilation, diaphragm mobility, arm mobility on the operated side, exercises for training the vestibular apparatus (various movements of the head in space). Massage of the back, chest, shoulder area on the operated side is carried out. On the 6-7th day after exercise, the patient gets up with the help of an instructor and takes a few steps around the ward. The elderly need special attention. If, when moving to a vertical position, they experience dizziness, palpitations, fainting, dizziness is possible, walking with the help is performed 2-3 days later.

On the 7-10th day, patients are transferred to a free mode, dosed walking along the corridor is allowed. Classes are held in the exercise therapy room by a small group method, paying special attention to posture. In addition to breathing exercises, they include coordination exercises, corrective exercises, as well as exercises with gymnastic objects and on shells.

On the 17-21st day, the total load increases due to walking up the stairs with a gradual increase in spans. The entire load part of the exercises is performed on the exhale. After mastering the complex of exercises, the patient repeats most of the complex independently 2-3 times a day, including walking up the stairs.

After discharge, patients after lobectomy and pulmonectomy continue to perform the complexes of physical exercises mastered in the hospital at home, supplementing them with outdoor walks. After 2 months after discharge, you can swim in the pool, in an open reservoir at an air temperature of at least 23-24 0 C and water of 21-22 0 C. Overheating and hypothermia are unacceptable. A further gradual increase in load should be monitored by a clinic doctor.

In patients with complicated postoperative course (divergence of seams, postoperative bleeding, suppuration in the pleural cavity, subcutaneous tissue, etc.), therapeutic exercises are prescribed after the elimination of complications.

An operation to remove a lung or part of it affected by a disease is prescribed in cases where their work becomes unsatisfactory. In this case, the function of breathing is taken over by healthy active areas. If the affected part is not removed, decay products and toxins will poison the body and provoke complications in the form of infections. In addition, the disease can spread to healthy tissues.

Immediately after surgery, shortness of breath appears, and ventilation of the lungs and the supply of oxygen to the body worsens. Phenomena such as palpitations, headaches and dizziness may be observed. You shouldn't be afraid of this. Such phenomena are the natural reaction of the body to the operation, the speedy recovery after which is facilitated by a number of measures, which we will discuss in this article.

You must completely stop smoking. Smoking is devastating for anyone, but especially for people who have had lung surgery. The smoke irritates the mucous membrane, provoking copious sputum, which is highly undesirable in the postoperative period. Due to excessive phlegm, a situation may arise when part of the lung is not completely filled with air, which can lead to inflammation of the lungs. If the patient cannot quit smoking on their own by willpower, due to excessive dependence, it is recommended to seek help from a psychotherapist.

In addition to smoking, other factors also have an irritating effect: gas contamination or dustiness of the air, the presence of toxic and highly active substances in the air. Such places should be avoided, and a humidifier or air ionizer should be installed at home.

The intake of large portions of alcohol depresses the respiratory function and weakens the body. The maximum dose of alcohol for postoperative patients is 30 g of ethyl alcohol for men and 10 g for women. For people with low weight, the dosage also does not exceed 10 g. People who have kidney failure, alcoholic damage to the heart, nervous system or liver should completely stop drinking alcohol.

Nutrition after surgery

For a speedy recovery, the body must receive complete and easy-to-digest nutrition. Meals should contain a sufficient amount of vitamins, nutrients and fiber. Mandatory in the diet are fresh fruits, juices, vegetables in various forms. At the same time, salt intake should be limited as much as possible. The daily norm of table salt does not exceed 6 g.

If the patient was obese or overweight before the operation, then after the operation it is vital to bring the body weight back to normal. This is extremely important, since excess weight significantly loads the cardiac and respiratory systems, increases shortness of breath.

Physical activity in the postoperative period

In order to avoid inflammation of the lungs caused by congestion in them, to debug the work of the intestines, to train the muscles involved in breathing, physical exercises are prescribed literally from the first hours after coming out of anesthesia. Against the background of drug treatment, all patients without restrictions on age and gender can continue physical training.

Performing exercises in the first hours after the operation prevents the formation of blood clots, congestion, activates the body's reserves, forcing those parts of the lung to work that may have been inactive before the operation, stimulates an early return to active life. Early activity means frequent changes in positions in bed. This gives work to the muscles, helps to "open" the lungs. Positions on the side and on the stomach can make breathing easier, and positions on the back with a raised head should be avoided.

When the body gets used to it, you can start training, but with a caveat: active exercises are contraindicated for people with shortness of breath at rest, with impaired vision, hearing, or motor functions. An acute infectious disease may also be a contraindication.

Relaxation

The most important component of the complex of physical exercises is relaxation. Relaxation begins with the legs, then the muscles of the arms and chest, then the neck. You can perform it in a standing or sitting position. When performing any physical exercises, the patient needs to remember that if one or another muscle group is not currently involved, then it needs to be relaxed. Each session of therapeutic exercises should end with a general relaxation of all muscles in the prone position.

Pain, anesthesia and low mobility make breathing shallow, which provokes stagnation in the airways. If there are no contraindications, then long and regular physical exercises are prescribed, as well as breathing exercises using a PEP bottle simulator or similar devices. A PEP bottle, roughly speaking, is a plastic container filled with water with a small tube inserted into it. The task of the patient is to inhale air through the nose and exhale through the mouth using a tube in a bottle. A positive result is noticeable after a few days of training. However, patients must continue physical activity and work with breathing simulators throughout their lives.

After a few months of regular training to strengthen the muscles, exercises with weights may be recommended.

The reason for stopping training may be:

• Sheer fatigue.
• Breathlessness stronger than usual.
• Spasms in the muscles.
• Sharp deviations from the norm of blood pressure.
• Excessive heartbeat.
• The appearance of pain in the chest.
• Dizziness, noises, beating, headache.

Medical treatment

In the postoperative period, the main task of the doctor and the patient is to prevent the accumulation of sputum in the lungs. Therefore, the medication prescribed by the doctor is mainly aimed at facilitating coughing. For this purpose, herbal teas, syrups and drugs that have an expectorant effect are used. In bronchitis with impaired patency in the bronchi, drugs are prescribed to expand the bronchus.

The treatment of vascular and heart diseases requires special attention, since they significantly affect the general condition of the body, worsen well-being, preventing the patient from full-fledged physical training. Almost all patients are prescribed drugs that facilitate the work of the cardiac system in the new conditions. However, any course of treatment should be prescribed and supervised exclusively by the attending physician.

In contact with

Classmates

Unfortunately, in case of lung injuries, diseases or complications, surgery is sometimes needed. After surgical treatment, a long recovery period is needed, in which breathing exercises, exercise therapy exercises, and special gymnastic exercises help. After dangerous injuries that occur due to damage to the bone corset of the chest, it is possible to injure the lung with a rib, as well as damage to the circulatory system, air entering the cavity behind the pleura. Also, operations are needed for suppuration of the lungs, tumors, while it is possible to remove part or all of the lung. At the same time, the operations themselves are very traumatic - to get to the respiratory organ, you need to go through the muscles, cartilage and the ribs themselves. Surgeons restore tightness and respiratory function, but you need to restore the functionality and fullness of breathing yourself.

People usually endure lung surgery very hard, so it is advisable to prepare them for this traumatic intervention with the help of gymnastic and physical exercises. Special exercises help with suppuration in the lungs, which cause intoxication. Due to the accumulation of pus in the lungs, which is accompanied by hemoptysis, it becomes harder to breathe, the human heart and brain work worse. Special physical activity helps to improve respiratory functions. Exercises to be done after surgery are also studied.

Of course, if there is bleeding in the lungs, the body temperature rises above 38 degrees, but without sputum accumulation, or third-degree cardiovascular insufficiency is diagnosed, there can be no talk of any therapeutic exercises, since it can be harmful and, possibly The patient needs to be operated on urgently.

• exercises that help the lungs drain up to ten times a day, half an hour before meals and at least an hour after meals;
• exercises that activate the reserve capacity of the cardiac and respiratory systems;
• simple exercise, but affecting all the muscles of the body;
• breathing exercises that use active breathing and hold it for a while;
• walks on flat terrain;
• moderate stair climbing.

After surgery

During surgery, internal organs are seriously injured. Not only muscles and ribs are damaged, but also nerve endings, which leads to pain after surgery, which, together with the inhibition of the respiratory center, leads to superficial gas exchange, impaired drainage of the lungs. After the operation, other complications also arise - contracture of the shoulder joint of a painful nature, embolism, thrombosis, pneumonia, intestinal atony, problems with the intestines, and others.

In the postoperative period, it is necessary to improve the performance of one part of the lung that has been preserved, to avoid complications, adhesions between the pleurae, and to develop the shoulder joint. Therapeutic exercises are prescribed for several hours after the operation, including breathing, since the patient must clear his throat.

Exercise in bed

1. In the early days, exercises related to diaphragmatic breathing or simply diaphragmatic breathing in the prone position are prescribed. The patient should lie down for one to three days, depending on the severity of the operation.
2. To develop the cardiovascular system, you need to work with distant limbs - forearms, hands, feet. You can’t get up yet, but in this way you can avoid congestion in the muscles.
3. From the second day shoulder joints are developed.
4. Lying on a healthy side, you need to inflate the balloons several times a day.
5. Massage is prescribed by tapping with fists, vibrating and stroking movements with the palms.
6. On the second or third day, you can lie on the sore side, and pull your legs to your stomach, lying on your side, imitate walking so that the lungs breathe more actively.

Recovery exercises

1. On the fourth or fifth day, the patient can exercise in a sitting position, classes should last up to ten minutes.
2. A week after the operation, you are allowed to walk and exercise for up to 20 minutes. During this period, it is necessary to stimulate trophic (nutritional) processes in tissues, restore posture. The shoulder should move in the same volumes as a healthy one. Breathing should not be diaphragmatic, but chest.
3. From ten days after the operation. Discharged for 10 - 12 days. You can do it at the gymnastic wall, with light dumbbells, a rubber band. You can also go outside, including walking freely on the stairs.
4. After a few months you need to play games that promote mobility - badminton, volleyball, table tennis. Recovery in full lasts up to six months, less often - longer.

After the operation, you need to examine the lung, whether it has expanded enough, if not, inflammation of individual areas is possible, which is preceded by shortness of breath. So check with your doctor regularly. Up to three months you need to do exercises that ventilate the lungs. You can do your homework, you need to eat in moderation without overeating. And, since this is a recovery process, nutrition should be healthy. You need to quit smoking and drinking, of course.

Pulmonary diseases are very diverse, and doctors use different methods to treat them. In some cases, therapeutic measures are ineffective, and in order to overcome a dangerous disease, one has to use surgery.

Lung surgery is a forced measure that is used in difficult situations when there is no other way to cope with the pathology. But many patients experience anxiety when they find out that they need such an operation. Therefore, it is important to know what such an intervention is, whether it is dangerous, and how it will affect a person’s future life.

It should be said that chest surgeries using the latest technologies do not pose any threat to health. But this is true only if the doctor who is involved in the implementation has a sufficient level of qualification, and also if all precautions are observed. In this case, even after a serious surgical intervention, the patient will be able to recover and live a full life.

Indications and types of operations

Operations on the lung are not performed without special need. The doctor first attempts to cope with the problem without using drastic measures. However, there are situations when surgery is necessary. This is:

• congenital abnormalities;
• lung injury;
• the presence of neoplasms (malignant and non-malignant);
• pulmonary tuberculosis in severe form;
• cysts;
• pulmonary infarction;
• abscess;
• atelectasis;
• pleurisy, etc.

In any of these cases, it is difficult to cope with the disease using only medications and therapeutic procedures. However, at the initial stage of the disease, these methods can be effective, which is why it is so important to seek help from a specialist in a timely manner. This will avoid the use of radical treatment measures. So even in the presence of these difficulties, the operation may not be prescribed. The doctor must be guided by the characteristics of the patient, the severity of the disease and many other factors before making such a decision.

Operations that are performed for lung diseases are divided into 2 groups. This is:

Pneumoectomy. Otherwise, such an operation is called a pulmonectomy. It involves the complete removal of the lung. It is prescribed in the presence of a malignant tumor in one lung or with a wide distribution of pathological foci in the lung tissues. In this case, it is easier to remove the whole lung than to separate the damaged areas. Removal of the lung is the most significant operation, since half of the organ is eliminated.

This type of intervention is practiced not only in relation to adults, but also for children. In some cases, when the patient is a child, the decision to perform such an operation is made even faster, since pathological processes in the damaged organ interfere with the normal development of the body. An operation is performed to remove the lung under general anesthesia.

Lung resection. This type of intervention involves the removal of a part of the lung, the one in which the focus of the pathology is located. Lung resection is of several types. This is:

• atypical lung resection. Another name for this operation is marginal lung resection. During it, one section of the organ located on the edge is removed;
• segmentectomy. Such resection of the lungs is practiced when a separate segment is damaged along with the bronchus. Intervention involves the removal of this area. Most often, when it is carried out, there is no need to cut the chest, and the necessary actions are performed using an endoscope;
• lobectomy. This type of operation is practiced when the lung lobe is affected, which has to be removed surgically;
• bilobectomy. During this operation, two lobes of the lung are removed;
• removal of a lung lobe (or two) is the most common type of intervention. The need for it arises in the presence of tuberculosis, cysts, tumors localized within one lobe, etc. Such a lung resection can be performed in a minimally invasive way, but the decision should remain with the doctor;
• reduction. In this case, the removal of non-functioning lung tissue is supposed, due to which the size of the organ is reduced.

According to the intervention technologies, such operations can be divided into two more types. This is:

• Thoracotomy operation. During its implementation, a wide opening of the chest is performed to perform manipulations.
• Thoracoscopic surgery. This is a minimally invasive type of intervention in which there is no need to cut the chest, since an endoscope is used.

Separately, the lung transplant operation, which appeared relatively recently, is considered. It is carried out in the most difficult situations, when the patient's lungs stop functioning, and without such intervention, his death will occur.

It is difficult to say how long the body will recover after surgery. Many factors influence this. It is especially important that the patient follow the recommendations of the doctor and avoid harmful effects, this will help minimize the consequences.

If only one lung remains

Most often, patients are concerned about the question of whether it is possible to live with one lung. It must be understood that doctors do not make the decision to remove half of the organ unnecessarily. Usually the patient's life depends on it, so this measure is justified.

Modern technologies for the implementation of various interventions allow you to get good results. A person who has undergone an operation to remove one lung can successfully adapt to new conditions. It depends on how correctly the pneumoectomy was performed, as well as on the aggressiveness of the disease.

In some cases, the disease that caused the need for such measures returns, which becomes very dangerous. However, it is safer than trying to save the damaged area, from which the pathology can spread even further.

Another important aspect is that after a lung is removed, a person should visit a specialist for routine checkups.

This allows you to detect a relapse in a timely manner and start treatment in order to prevent similar problems.

In half of the cases after pneumoectomy, people get a disability. This is done so that a person can not overstrain while doing their job duties. But receiving a disability group does not mean that it will be permanent.

After some time, disability can be canceled if the patient's body has recovered. This means that living with one lung is possible. Of course, precautions will be required, but even in this case, a person has a chance to live a long time.

Regarding the life expectancy of a patient who underwent lung surgery, it is difficult to argue. It depends on many circumstances, such as the form of the disease, the timeliness of treatment, the individual endurance of the body, adherence to preventive measures, etc. Sometimes a former patient is able to lead a normal life, practically without limiting himself in anything.

Postoperative recovery

After an operation on any type of lung has been performed, the patient's respiratory function will be impaired at first, so recovery implies the return of this function to a normal state. This happens under the supervision of doctors, so the primary rehabilitation after lung surgery involves the patient's stay in the hospital. D

In order for breathing to normalize faster, special procedures, breathing exercises, medications and other measures can be prescribed. All these measures the doctor selects on an individual basis, taking into account the characteristics of each specific case.

A very important part of recovery measures is the nutrition of the patient. It is necessary to clarify with the doctor what you can eat after the operation. Food doesn't have to be heavy. But to restore strength, you need to eat healthy and nutritious food, which is rich in protein and vitamins. This will strengthen the human body and speed up the healing process.

In addition to the fact that proper nutrition is important at the recovery stage, other rules must be observed. This is:

1. Complete rest.
2. The absence of stressful situations.
3. Avoiding serious physical effort.
4. Implementation of hygiene procedures.
5. Taking prescribed medications.
6. Quit bad habits, especially smoking.
7. Frequent walks in the fresh air.

It is very important not to miss preventive examinations and to inform the doctor about any adverse changes in the body.

Removal of a lung, its lobe or segment, as a rule, is associated with very serious painful changes in the structure of the lung tissue. It is impossible to leave the affected lung tissue, it poisons the body with tissue decay products, the pathological flora “living” in this area constantly produces toxins and tends to spread beyond the affected area.

The development of pathological changes in the lungs can have a different causality: complications after pneumonia, infections, the specifics of the individual development of the body, heredity, bad habits - you can’t list everything. The disease develops gradually and up to a certain point the body copes with the powerful intoxication that the affected area of ​​the lungs provides, and the breathing volume necessary for life is provided by a healthy, functioning part of the lungs. However, the disease develops and there comes a point when surgery becomes the only means of saving the patient's life.

The operation was performed, the patient's life is out of danger. However, surgery to remove part of the lung is a very difficult intervention. The chest, pleura were dissected, a section of the lung was excised - the interventions are very large-scale and significant for the body. In addition, the patient receives massive drug therapy against the background of a general weakening of the body associated with the course of the underlying disease.

You do not need to be a medical professional to understand that in this case a person needs serious and long-term physical rehabilitation, the purpose of which is to restore the quality of life.

What happens after surgery?

The first is a deterioration in the supply of oxygen to the body. Shortness of breath, weakness increases, headache, chest pain, heart problems, and heart rate may become more frequent. It must be understood that all these problems are associated with a decrease in the size of the lung after surgery - a void has formed in the chest.

The formation of empty space inside the chest seriously affects the state of the body. It leads to a change in the habitual ratios of intracavitary pressures in the macrocavities of the body that have developed during the growth and development of the body: the pelvic cavity, the abdominal cavity, the chest as a cavity, as well as to a change in the existing spatial arrangement of organs. Syntopy and skeletotopy of organs are changing, that is, the location of organs relative to other organs and relative to the skeleton. Abdominal organs: stomach, intestines and organs located in the chest: lungs, heart, aorta, esophagus begin to shift and these spatial structure disorders further aggravate the patient's condition, leading to malfunctions in other body systems due to changes in the conditions of blood supply and innervation of organs - tension or compression of nerve trunks and vascular bundles.

Another problem after surgery is pleural adhesions and others. Adhesions limit changes in the linear dimensions of the remaining parts of the lungs, thereby reducing tidal volumes. Residual intoxication is also a problem after the operation - the affected part of the lung is removed and no longer poisons the body, however, the lung is a sponge in its structure and a large amount of unnecessary waste products remain in its pores that need to be drained. remove from the body.

Is it possible to help the body adapt more quickly and more fully after such a serious surgical intervention?

What rehabilitation tasks should be solved during the implementation of the rehabilitation program?

The first task is to “breathe” the remaining parts of the lungs and drain, clean them out using special active drainage techniques.

The second task is to help the body in the process of spatial restructuring. It is necessary to actively form the statics and dynamics of the body, as well as the balance of pressures in the macro cavities of the body.

The third task is to restore lung displacement, for this it is necessary to eliminate adhesions, but not by surgery, but again with the help of physical rehabilitation methods, that is, with the help of special exercises!

All these tasks are successfully solved in our clinic.

It must be said that we do not accept everyone for rehabilitation!

Admission for treatment is carried out after consultation with our specialists.

1. Pulmonary tuberculosis.

3. Diseases accompanied by copious sputum.

4. Purulent diseases: lung abscess, pleural empyema.

5. Acute pneumonia.

7. Fevers of unknown origin.

To conduct a gymnastics course, patients with diseases of the respiratory system must pass a general blood test, sputum analysis (if it is separated), undergo a fluorography (or an overview of the chest).

Bronchial asthma is a chronic inflammatory and allergic disease of the respiratory tract associated with increased reactivity of the bronchi and a tendency to spasm, narrowing of their lumen. As well as the accumulation of thick viscous sputum in them. The disease is caused by specific - allergies, sensitization to plant pollen, animal hair, house dust and other allergens, and non-specific - harmful environmental factors (smoke, various gases, aerosols and mineral dust) mechanisms. The development of the disease is facilitated by a genetic predisposition, certain environmental conditions. The disease is manifested by difficulty in breathing, dry wheezing and periodic attacks of suffocation that occur upon contact with an allergen, physical activity, exposure to cold air, against the background of respiratory viral infections. The course of bronchial asthma can be of different types: mild intermittent, persistent, moderate and severe with the development of respiratory failure. Treatment of bronchial asthma includes an integrated approach - avoidance of contact with allergens, drug inhalation (bronchodilator and anti-inflammatory) therapy. Rehabilitation measures (physiotherapy exercises, breathing exercises, homeopathic method) aimed at improving the quality and life expectancy of a person suffering from asthma are of great importance in the management of patients with asthma.

Chronic obstructive pulmonary disease (COPD).

This is a disease of the upper and lower respiratory tract of an inflammatory and steadily progressive nature, which is based on the difficulty and restriction of air entry into the respiratory tract, due to the constant irritation of the lung tissue by various harmful microparticles, mineral dust, cigarette smoke, hot air, high humidity. The disease is manifested by a constant cough, with expectoration of mucopurulent or purulent sputum, wheezing in the lungs, shortness of breath when walking and other physical exertion. In the future, it leads to the development of emphysema, pneumosclerosis of respiratory failure and gradual disability of the patient. The main method of treatment is anti-inflammatory therapy and the rejection of exposure to harmful factors. An important role is played by non-drug methods of influence (homeopathy, herbal medicine) and rehabilitation measures: physiotherapy exercises and breathing exercises; which increase the vital capacity of the lungs, increase the drainage of stagnant sputum and reduce the further progression of the inflammatory process in the lung tissue.

Acute lobar or focal pneumonia is one of the most common diseases of a bacterial nature, characterized by severe intoxication, fever, cough and shortness of breath. It occurs against the background of a respiratory infection, chronic bronchitis, obstructive pulmonary diseases, under conditions of a decrease in the body's defenses, the presence of concomitant chronic diseases, increased physical activity, smoking. It is caused by various bacterial agents that are normally present in the lumen of the bronchi on the mucous membrane, but under conditions of decreased immunity become pathogenic (that is, they can cause inflammation of the lung tissue). In the acute stage of the disease, inflammatory exudate accumulates in the lumen of the alveoli and at this stage antibiotic therapy is carried out; an increase in the volume of movements of the chest and an increase in the vital capacity of the lungs. A set of specially designed exercises on medical simulators leads to an increase in the drainage function of the lungs, an increase in ventilation and blood supply to the lung tissue, as a result of which the process of resorption of the inflammatory focus is accelerated and the risk of developing complications of acute pneumonia (focal pneumosclerosis, pleurodiaphragmatic adhesions, lung abscess, respiratory failure).

In our clinic, there is the possibility of using complex methods of exposure for all of the listed diseases: exercise therapy according to the original author's method on special simulators under the supervision and direct guidance of the author of the method and experienced exercise therapy instructors, massage, homeopathic treatment. As a result of regular exercises, the tone of the muscles of the chest increases, the vital capacity of the lungs increases. the discharge of stagnant sputum improves, as a result of which the lumen of the bronchi expands, the frequency and intensity of asthma attacks decrease, which makes it possible to subsequently reduce the dose of inhaled drugs taken and begin to breathe freely.

Rehabilitation and recovery after lung surgery

• pneumonia
• Chronical bronchitis
• allergic bronchopulmonary aspergillosis
• alveolar microlithiasis
• bronchial asthma idiopathic fibrosing alveolitis
• pulmonary hypertension
• pulmonary alveolar proteinosis
• pulmonary fibrosis
• sleep apnea
• osteochondroplastic tracheobronchopathy pneumonia
• chronic bronchitis (smoker's bronchitis, etc.)
• exogenous allergic alveolitis
• tracheobronchitis chronic obstructive pulmonary disease:
• pneumosclerosis
• emphysema

Breathing exercises

Under the influence of breathing exercises, the activity of the entire respiratory apparatus improves: the respiratory muscles are strengthened, the mobility of the chest increases. Breathing becomes less frequent and deeper, the vital capacity and maximum ventilation of the lungs increase, the level of the respiratory reserve increases. With a deep breath, the diaphragm exerts pressure on the liver, as a result of which favorable conditions are created for the outflow of blood from the abdominal organs, and the flow of blood into the inferior vena cava and into the right heart is facilitated. The filling of the right atrium is also facilitated by the negative pressure that forms in the chest cavity during deep inspiration. Breathing exercises used for 10-15 minutes have a general inhibitory effect for a long time, calm the patient and distract him from the heavy thoughts associated with the upcoming operation. Depending on the method of conducting breathing exercises, we distinguish the following exercises.

1. Static breathing in the starting position lying on your back or sitting. This is primarily a task to count the number of breaths per minute. Under the influence of this exercise, breathing becomes rare, rhythmic.

Exercise options: breathing at the expense of a methodologist or under a metronome, breathing with an extended exhalation, with an inhalation delay for 3-5 seconds.

We also used chest breathing. The patient was asked to breathe from the chest, and for control, the methodologist's hands were placed on the chest with slight pressure.

Static diaphragmatic breathing with forced exhalation. When performing diaphragmatic breathing, for control, the patient puts one hand on the chest, the other on the stomach.

Dynamic breathing. Breathing exercises in combination with movement: when inhaling - spreading the arms to the sides, raising the arms up, unbending the torso, straightening the legs; when exhaling - bringing and lowering the arms, tilting the torso, bending the legs by squatting.

Special breathing exercises. Exercises that increase ventilation of individual (healthy) lobes of the lung or the whole lung. This is achieved by mechanical compression of the chest on the side of the affected lung, as well as by lying on the affected side with a padded roller.

If the process is localized in the lower lobe of the right lung, one should strive to maximize the breathing of the middle and upper lobes. This is achieved by squeezing the lower chest on the right. Ventilation of the lower lobes is enhanced when performing exercises in the starting position - hands behind the head.

CHAPTERVI

POSTOPERATIVE PERIOD

Exclusion from gas exchange of the lung or its share due to surgery, damage to the neuromuscular apparatus, the flow of pain impulses from the area of ​​intervention, inhibition of the drainage function of the bronchial tree and the accumulation of mucus and sputum in it drastically disrupt the function of external respiration. Postoperative anemia leads to insufficiency of internal respiration; often occurring primary hemodynamic disorders also contribute to the disruption of oxygen transport by the blood. Adrenocortical insufficiency associated with the operation aggravates the developing circulatory disorders, leads to a decrease in the volume of circulating blood, a drop in vascular tone, and thereby aggravates the patient's condition.

The summation of all these negative factors causes functional shifts in the body after lung surgery, among which the leading place belongs to hypoxia with the development of acute respiratory failure.

The adaptability of the body to new conditions of existence and the outcomes of surgical interventions mainly depend on the degree of development of compensation for impaired functions, the usefulness of the disclosure of reserve possibilities of breathing and blood circulation.

Blood oxygen saturation in the first 1-2 days after surgery can decrease to 80%, blood pH to 0.1, the amount of carbon dioxide in the blood increases, and the breathing rhythm is often disturbed. Usually, in the first days after surgery, no significant difference in blood oxygen saturation after pneumonectomy and lobectomy can be detected (after partial resection of the lung (bilobectomy, lobectomy), the decrease in blood oxygen saturation can be longer and more significant than after pneumonectomy. This phenomenon is obvious , is observed in cases where the remaining part of the lung does not expand for a long time; an arterio-venous shunt is created in the collapsed lobe, the discharge of non-oxygenated blood into the systemic circulation further impairs gas exchange after surgery.

The resulting hypoxia has an extremely adverse effect on the course of the postoperative period. N. M. Amosov rightly notes that most complications after pulmonary operations are associated precisely with hypoxia, leading to secondary cardiac weakness, pulmonary edema, impaired blood circulation, thrombosis, etc.

In thoracic patients, 4.6-29% develop acute postoperative respiratory failure. Compensation for respiratory disorders occurs mainly during the first week after surgery (in the absence of complications during the postoperative period). At this time, blood oxygen saturation improves. The final normalization of the parameters of the function of external respiration occurs over a long period, they gradually increase within 5-6 months after the operation. The formation of adhesions, adhesions, fibrothorax has a significant effect on them. deformity of the chest, which reduce the reserves of external respiration

Changes in hemodynamics after surgery, on the one hand, can be directly related to blood loss and the severe injury that the patient suffered due to radical lung surgery, on the other hand, they are due to gas exchange disorders that have arisen.

The body seeks to eliminate these disorders of gas exchange, primarily by compensatory hyperfunction of the cardiovascular system. In the first 3-4 days after lung surgery, there is a regular hyperfunction of the cardiovascular system, which is expressed in an increase in heart rate (by 34% on average), which causes an increase in minute blood volume (by 32% on average compared to baseline data). There is also an acceleration of blood flow, an increase in vascular tone, manifested by arterial and venous hypertension, by 4.4 and 40%, respectively, compared with the preoperative level.

These changes in hemodynamics accelerate the delivery of oxygen to tissues and contribute to the elimination of oxygen deficiency, which is constantly observed after pulmonary operations.

From the 6-7th day after the operation, with the improvement of the general condition of patients, gas exchange disorders become less pronounced and there is a tendency to reduce the compensatory hyperfunction of the cardiovascular system. Hemodynamic shifts gradually level off and by the time the patients are discharged, hemodynamic parameters usually approach the preoperative level. Compensatory processes pass into a phase of relative stabilization.

The situation is different with the development of certain postoperative complications (pneumonia in the remaining lung, pleurobronchial fistula, etc.). Complications exacerbate the existing respiratory failure, which is compensated for a certain period as a result of a more intense activity of the heart. With the usefulness of the body's reserve forces, after the elimination of the developed complications, or during "adaptation" to them, as, for example, happens in a number of cases in the presence of a bronchial fistula, the compensatory hyperfunction of the cardiovascular system decreases and the hemodynamic parameters gradually normalize.

CHAPTERVII

PHYSIOTHERAPYIN THE POSTOPERATIVE PERIOD

As mentioned above, lung surgery causes profound changes in the body due to surgical trauma and a decrease in the respiratory surface. When a lobe of the lung is removed, and especially after pulmonectomy, new hemodynamic conditions arise due to the shutdown of part of the pulmonary circulation. A sharp increase in heart rate, shortness of breath indicate a high degree of tension of the compensatory forces of the body, aimed at reducing the phenomena of pulmonary and pulmonary heart failure. In persons with good compensatory abilities, shortness of breath and tachycardia are less pronounced, and adaptation to new conditions of breathing and blood circulation occurs in a shorter time. The development of compensation processes during operations on the lungs depends on the state of a healthy lung, chest excursion, the state of the central nervous system, which also suffers from circulatory and respiratory disorders. Pulmonary complications - pneumonia, atelectasis - sharply worsen the condition of patients in the postoperative period, and sometimes cause deaths.

The processes of respiratory compensation come faster and are more stable in persons who were actively engaged in physical exercises before surgery and in the postoperative period. Apparently, preoperative training contributes to the development of compensatory processes after surgery. Therapeutic gymnastics in

postoperative period plays an even greater role. First, new conditioned reflex connections are established between the motor apparatus and the respiratory center under conditions of a remote lung or lobe. Secondly, through the reticular formation of the brain stem, tonic effects on the cerebral cortex are carried out, which improves the general well-being, mood of the patient and contributes to a better course of the postoperative period. Thirdly, during therapeutic exercises, afferent impulses entering the central nervous system from the muscles exert tonic effects on the vasomotor and other subcortical centers, improving the supply of oxygen to the whole organism.

We consider it expedient to use early therapeutic exercises in the first hours after surgery. V. I. Struchkov (1958) recommends to force patients to clear their throats from the first hours after the operation, and from the 2-3rd day to conduct active therapeutic exercises in a sitting position.

N. M. Amosov (1958) notes that therapeutic exercises contribute to more stable compensation of the cardiovascular system, since physical exercises affect extracardiac factors, the suction action of the chest, and blood flow to the myocardium.

Keguap (1956) recommended early movements of the chest and movements in the shoulder joint on the operated side, active breathing with resistance. His technique provides for a long, several hours, breathing exercises. With such use of physical exercises one cannot agree, because this can lead to hyperventilation and general overwork. We also do not consider justified the use of therapeutic exercises on the 2nd day after the operation, as Kees advises! (1953), since the patient experiences special difficulties in breathing in the first hours after the operation. During this period, expectoration of sputum is difficult, conditions are created under which the formation of mucous plugs, the development of pneumonia and other pulmonary complications are possible.

Characteristic in foreign literature is the localistic interpretation of the influence of therapeutic exercises, limiting its impact on improving coughing, restoring breathing, and straightening the lung.

At the same time, physical exercises have a much greater effect on the patient as a factor that increases the body's compensatory forces. In this regard, the method of therapeutic exercises should provide for the impact not only on the area of ​​operation. The complexes of therapeutic gymnastics should include exercises that improve the condition of the circulatory system, digestion, and the central nervous system. The Soviet school of physical therapy considers physical exercises as a method of functional therapy.

The following tasks are faced by therapeutic exercises in the postoperative period:

Prevention of pulmonary complications by improving ventilation of the lungs, drainage of the bronchi, straightening the remaining part of the lung.

Prevention of disorders of the gastrointestinal tract (paresis of the stomach and intestines).

Prevention of phlebothrombosis by improving venous circulation.

The maximum development of the compensatory capabilities of the lungs and the cardiovascular system.

Prevention of limited mobility in the shoulder joint on the operated side, posture disorders and chest deformities.

In the late postoperative period, therapeutic exercises face the following tasks:

1. Training of the cardiovascular and respiratory systems. . ■ , .

Restoration of the full range of motion of the shoulder joint on the operated side.

Correction of deformities of the chest and spine, strengthening of all muscle groups, increasing the mobility of the chest and diaphragm.

Preparation of patients for household and industrial loads.

Therapeutic exercises in the postoperative period are necessary for all patients, except for a small group, for whom it is temporarily contraindicated.

Contraindications to physiotherapy exercises:

Severe acute cardiovascular failure, regardless of the cause of its occurrence (heart failure, shock, blood loss).

Severe acute respiratory and cardiopulmonary failure, excluding the possibility of additional physical activity.

After the operation, it is advisable to do the exercises that were mastered by the patient during the preoperative preparation. Classes can be started 1-2 hours after the end of anesthesia. In this period immediately after the operation, exercises are carried out that help the patient learn to breathe correctly faster, facilitate the separation of mucus and sputum from the respiratory tract, improve pulmonary ventilation, help cough up sputum and induce coughing. In the first hours it is very important to inspire the patient with confidence in the successful outcome of the operation.

Along with this, light exercises for small muscle groups are carried out, which improve peripheral blood circulation. The session lasts 3-5 minutes and is repeated 3-4 times during the day. In the future, the motor regime expands and, starting from the 2nd day, therapeutic exercises are carried out according to the complexes in accordance with the tasks that are set at this stage of treatment.

According to our observations, it is advisable to divide the course of therapeutic exercises after surgery into three periods depending on the tasks at hand:

the first (early) period, from the 2nd to the 5th day after the operation, i.e., until the patient is raised to his feet;

the second (intermediate) period - from the 6th to the 11th day, during which, with an uncomplicated course

Physiotherapy the patient is allowed to get up and move independently around the ward;

the third (late) period - from the 12th day to the discharge of the patient from the clinic.

Such periodization of therapeutic exercises in the postoperative period is due to the clinical condition of the patients.

First (early) postoperative period. The tasks of this period are to maintain general tone, fight against atelectasis, prevent pneumonia, thrombophlebitis, intestinal atony. During this period, up to the 4th-5th day after the operation, the majority of patients experience cardiovascular and pulmonary insufficiency. The vital capacity of the lungs and maximum ventilation at this time do not exceed 50% in relation to the preoperative period. During the first 5-6 days, the physical capabilities of patients are limited. Classes are held with each patient.

Along with the exercises (complex 2), it is advisable to apply from the 2nd day a light massage of the chest * ki, lower extremities using rubbing and tapping techniques. Starting from the 3rd day, the range of motion in the shoulder joint increases. Patients more actively perform exercises with the rotation of the body, bending the legs at the knee and hip joints.

In seriously ill patients with pulmonary and pulmonary heart failure, it is advisable to combine therapeutic exercises with oxygen inhalation.

After pulmonectomy, pulmonary complications are especially dangerous. Therefore, therapeutic exercises in such pain-puffs must be carried out repeatedly and carefully. From the 2-3rd day, if the patient's condition allows, he can perform breathing exercises lying on the operated side, since in this position the excursion of the healthy half of the chest improves, ventilation of the lung increases and conditions for sputum production improve. Particular care should be taken when conducting classes in case of displacement of the mediastinum. For such patients, the load should be reduced.

In the process of practicing therapeutic exercises, it is necessary to constantly monitor the state of the pulse, respiration, blood pressure and strictly observe the principle of matching physical activity to the patient's condition. In the process of training, the patient should not experience fatigue and severe pain. It is necessary to strive for complete painlessness of the procedure of therapeutic exercises.

The second (intermediate) postoperative period. On the 6-12th day, according to our observations and literature data, blood oxygen saturation normalizes, the pulse becomes less frequent, breathing becomes deeper. During this period, patients are transferred from the intensive care unit to general wards; end of bed rest. Physiotherapy classes at this time can be carried out in a group method in the physiotherapy room. The motor mode expands in accordance with the general condition of the patient. During this period, therapeutic gymnastics faces the following tasks:

contributing to the further development of the function of a healthy lung or the remaining part of the lung (post-lobectomy;

training of the cardiovascular system;

development of mobility of the shoulder joint on the affected side;

prevention of deformities of the shoulder girdle, chest and spine.

A number of exercises of the first period constitutes an introductory part to the second stage of treatment. In addition, patients perform general strengthening exercises for the upper and lower extremities, torso. On the 9-11th day, some patients perform exercises with shells (gymnastic stick, dumbbells 1-1.5 kg).

When conducting classes, it is necessary to monitor the correct observance of the starting positions and, if possible, the exact execution of exercises. In the late postoperative period, there is no need to conduct classes “every 2-3 hours. It is enough to practice 3 times a day for 25-30 minutes with pauses between exercises. During this period, when performing exercises aimed at straightening the remaining lobe of the lung after lobectomy, it is recommended to start in a lying position on a healthy side with a cushion placed on it. It is advisable to give exercises with inflating oxygen bags, often (3-4 times a day) determining the vital capacity of the lungs. When removing the lower or middle lobe of the lung, along with diaphragmatic breathing, which enhances ventilation of the lower lobe of a healthy lung, from the first days after the operation, it is recommended to widely use chest breathing with an extended exhalation to straighten the remaining upper lobe of the lung. When removing the upper lobe, deep diaphragmatic breathing is shown to enhance ventilation of the lower lobes.

Breathing exercises that increase the ventilation of individual lobes of the lung are undoubtedly advisable, but they should be supplemented by light pressure on that part of the chest, the excursion of which we are trying to activate. After straightening the lung in the postoperative period and removing the drainage, therapeutic exercises should not be stopped.

After pneumonectomy, from the first hours after the operation and in subsequent periods, it is necessary to activate the ventilation of the remaining lung with the help of passive exercises, massage. This can be achieved by compressing the chest on the side of the healthy lung during exhalation and doing breathing exercises in the starting position on the operated side.

Third (late) postoperative period. In this period, on the 12-14th day, the wound heals, sutures are removed, in most patients breathing and blood circulation are largely compensated, and physical capabilities increase. Before therapeutic gymnastics during this period, the task is to contribute to the rapid and complete compensation of the functions of the cardiovascular and respiratory systems. However, it should be borne in mind that in some cases we are forced to deviate from this scheme, especially when managing patients with a complicated postoperative course, as well as when exercising with elderly people suffering from pneumosclerosis, pulmonary emphysema, and diseases of the cardiovascular system. Patients continue to inflate oxygen bags and perform other exercises that help straighten the lung. At this stage of treatment, great attention should be paid to the training of the cardiovascular system, the development of muscle strength (especially the shoulder girdle,

back and abdomen), the formation of posture, strengthening the shoulder girdle, preparing the patient for domestic and industrial loads. During this period, a significant part of the exercises (about 60%) is performed in the initial position, sitting and standing. Exercises are used with a gymnastic stick, light dumbbells, stuffed balls.

Having a training effect on the cardiovascular system and respiration, these exercises should not tire the patient. During this period, there is no need to apply the exercises recommended by some authors associated with holding the breath, straining, as well as movements that are difficult to coordinate. In the process of performing exercises, it is necessary to monitor the position of the head, shoulders, torso. The correct methodological technique is to conduct classes in front of a mirror.

not cause excessive fatigue of the patient, sharp pain in the area of ​​the operated wound;

reasonable motor activity of the patient should be encouraged;

during the early postoperative period, one should not change the position of the patient in bed, if it does not harm, and take it as the starting position for physical therapy;

exercises should be performed at a calm pace and combined with breathing phases.

Patients after pulmonectomy perform exercises with a more limited motor regime than after lobectomy. During classes, systematic monitoring of the state of the cardiovascular system and breathing is necessary. Before, during, and after exercise, check your pulse, blood pressure, and respiratory rate. Depending on these data, the general condition and age of the patient, physical activity is dosed accordingly.

Therapeutic exercises in the preoperative and postoperative periods in combination with oxygen therapy are carried out according to general complexes (schemes 2 and 3).

Sound gymnastics can be attributed to specific types of training of the external respiration apparatus. It consists in the application of special exercises related to the pronunciation of sounds and their combinations in a certain sequence and in a certain way with the obligatory initial performance of two exercises: “closed groan” - mmm and “cleansing exhalation” - pff. Sound gymnastics contributes to the formation of the correct alternation of the phases of inhalation, exhalation and respiratory pause; due to vibration, it relaxes spasmodic bronchi, promotes better evacuation of sputum; due to the creation of a small positive pressure on exhalation (PEEP mode), it increases the uniformity of alveolar ventilation and prevents the frame from expiratory closure of the airways (ECAP). ), active exhalation through the mouth (2-4 s), pause (4-6 s). Sound gymnastics is mainly used for obstructive pulmonary diseases. The advantages of sound gymnastics include the possibility of almost constant use on an outpatient basis after preliminary training of patients.

In addition to sound gymnastics, special devices are used to create the MPCI mode - mouthpieces for exhalation passivation and nebulizers (nebulizers), as well as breathing under water through a thin tube and inflating rubber balloons or beach balls.

In patients after operations on the lungs, respiratory equipment is used to create a PEEP regimen. When prescribing the PEEP mode, it is not recommended to increase the pressure in the system by more than 15 cm of water. Art., due to the possibility of complications. These include: 1) a decrease in cardiac output due to a decrease in venous return, changes in the geometry of the ventricles and the order of the heart, violations of the central mechanisms of regulation of hemodynamics; 2) a decrease in oxygen delivery to tissues due to a decrease in cardiac output; 3) the possibility of increasing extravascular water in the lungs (edema); 4) increased intracranial pressure; 5) barotrauma.

The original methods of breathing exercises include the method of volitional elimination of Buteyko deep breathing. According to this technique, patients produce a slow very superficial exhalation of 3-4 s and fix a pause of 3-4 s. The respiratory rate should be within 6-8 seconds per minute. Training is carried out constantly, at least 3 hours a day, first at rest, and then when moving. In addition, the author of the technique recommends at least 3 times a day to produce 2-3 maximum breath holdings, bringing their duration to 60 seconds or more.

K. P. Buteyko’s technique can have some therapeutic effect in some patients with bronchial asthma, since the resulting hypercapnia and a decrease in air velocity in the bronchi reduce irritation of irritant receptors in the bronchi. At the same time, it should be noted that approximately 2/3 of patients develop a recovery reaction called by the author with symptoms characteristic of hypercapnia (drowsiness, headache, muscle pain, chills, fever, insomnia) and there is a danger of a deep acid disorder. -alkaline balance.

Breathing according to the method of A. N. Strelnikova has not become widespread, mainly due to the technically complex implementation and the lack of significant advantages compared to other types of respiratory gymnastics. To train the respiratory muscles, the author of the technique proposed to create a kind of resistance for the muscles involved in the act of breathing by performing movements that compress the chest during inhalation.