Four cores of rehabilitation exercise after lung surgery

      Surgical resection is an important method to treat early lung cancer and benign lung disease.

　　With the development and popularization of minimally invasive technology, minimally invasive lobectomy, segmental resection and wedge-shaped resection of the lung have become routine surgical methods.

　　Minimally invasive surgery is characterized by light pain, fast recovery and beautiful incision. Generally, the hospital stay after lobectomy is 3-5 days, and that after segmental resection and wedge resection is 2-3 days.

　　Many patients and their families think that this recovery speed is incredible, but a large number of facts have proved that this recovery speed can be achieved through active rehabilitation activities.

　　So, what kind of rehabilitation exercise should be carried out after lung surgery? After a long period of practice, the author summarized four core contents of rehabilitation after pneumonectomy, namely, active cough, active activity, diet control, and overcoming pain.

　　Core 1: active cough.

　　Active cough refers to the patient's deliberate cough when he does not want to cough.

　　Active cough is the primary core of postoperative rehabilitation exercise. The recovery speed and removal time of thoracic drainage tube largely depend on the quality of cough exercise.

　　Active cough can bring the following benefits to patients:

　　1. Discharge sputum to prevent lung infection.

　　Lung collapse is required during operation, so as to create space for development of operation ability.

　　After the collapse of the lung, the sputum secreted by the small airway cannot be discharged in time.

　　In addition, the pulmonary resection system itself will directly lead to the production of a red bloody sputum in some patients' lives.

　　If the sputum accumulates in the lungs, it will cause fever and other lung infections in many patients.

　　If concentrated in the large airway, it will affect the patient's chest tightness and dyspnea.

　　Once these work situations occur, we will increase the use of antibiotics, and even the society needs to study the use of general anesthesia tracheoscopy for sputum suction, or endotracheal intubation ventilator assisted breathing and other traumatic treatment methods.

　　Patients spend a lot of money and suffer. Some patients even suffer cell death due to severe lung infection or respiratory failure.

　　If you insist on coughing actively, you can begin to cough up sputum gradually, keep the airway and lungs clean and unobstructed, and promote the rapid recovery of patients.

　　2. Put it in the lungs to expel pleural liquid gas.

　　After pneumonectomy, a small amount of blood will definitely ooze from the surgical wound, and the cut lung tissue will often have air leakage for a period of time.

　　Therefore, it will definitely appear in the chest after surgery.

　　In order to drain excess fluid and gas, the doctor placed a chest drainage tube during the operation.

　　However, these excess liquids and gases will not automatically be discharged from the thoracic drainage tube, and the lungs will be expanded by coughing, and the excess liquids and gases will be squeezed through the thoracic drainage tube.

　　The chest tube is a one-way channel, in which the gas and liquid can only flow out of the chest, but can not enter the chest in turn.

　　Therefore, cough leaves less and less liquid and gas in the chest.

　　When the gas is no longer discharged when coughing, when the pleural effusion shunts less than 300ml for 24 hours, and the patient approaches the discharge standard, the use of pleural drainage tube can be considered.

　　So, how to cough after the operation?

　　Generally speaking, except for the time of eating and sleeping, patients are required to cough 20~30 times every 30 minutes, and the intensity of the cough should reach the obvious fluctuation of the water column in the chest tube.

　　However, it is important to avoid persistent, severe and rapid coughing to avoid airway spasm and dyspnea.

　　Core 2: Active activities.

　　Active activity refers to active activity on the bed or ground after surgery.

　　Postoperative active activity can restore the upright state of the body, promote the normal distribution of blood flow and oxygen in the lungs, and rely on gravity to drain the fluid from the chest.

　　In addition, another important role of active activities is to reduce the risk of acute pulmonary embolism.

　　There are two systems in the human blood system: coagulation and anticoagulation. The balance of these two systems is an important prerequisite for maintaining the flow of human blood in blood vessels.

　　Once the balance is disturbed, the body will show a disease state.

　　If the anticoagulation system is stronger than the coagulation system, the body will bleed.

　　If the coagulation system is stronger than the anticoagulation system, blood clots will appear in the body.

　　Surgery, anesthesia, old age, obesity, malignant tumor, pain, muscle inactivity and other factors will lead to too strong coagulation system and increase the risk of thrombosis. Thrombosis is most likely to occur in the deep veins of the lower extremities.

　　After DVT, the patient may have unilateral leg swelling and pain.

　　When the deep vein thrombosis of the lower limb falls off, it circulates into the pulmonary artery, causing pulmonary embolism. The patient may have severe chest tightness and hypoxemia, which is difficult to correct by oxygen inhalation, and sudden death may occur in severe cases.

　　Active activities increase blood flow to lower limbs and the whole body through muscle contraction and relaxation functions. With the flow of blood, the risk of thrombosis naturally decreases.

　　This truth is just like the old saying: "Running water does not rot, and household hinges do not worm."

　　How did you move after the operation?

　　On the second day after the operation, you should not get out of bed. You should stretch your legs, curl your legs, feet, hooks, etc.

　　On the first day after the operation, the patient will come down to exercise. When we have to overcome the pain, we should overcome the inconvenience of chest intubation, chest bottle, infusion, and adhere to daily activities.

　　The specific activity intensity depends on the physical recovery of each patient. The physical recovery is good, and there is no dizziness, nausea, chest tightness and other symptoms. On the contrary, the activity can be appropriately reduced.

　　Core 3: diet control.

　　Diet control refers to the adjustment and control of diet structure before and after pulmonary resection.

　　Generally speaking, lung surgery does not involve passing through the gastrointestinal tract, which has less impact on diet than the gastrointestinal system.

　　However, pulmonary surgery belongs to its own general anesthesia operation, and anesthetic research drugs can lead to paralysis of gastrointestinal management function.

　　In addition, depending on the patient, thoracic duct or small lymphatic vessel damage may occur.

　　Therefore, there are still some problems that we need to pay special attention to after lung surgery.

　　Three meals can be eaten normally during the activity on the day before operation. During the period from 12pm before operation to 6am after operation, the patient shall be strictly forbidden to eat and drink.

　　Drinking warm water 6 hours after the operation on that day. Light liquid diet or semi liquid diet can be taken on the first day after operation.

　　At this time, the patient has not yet exhausted and defecated, and the demand for gastrointestinal motility has not been completely restored. It must be based on a digestible diet culture. Liquid or semi liquid carbohydrate food can be selected, such as juice, millet gruel, rice gruel, noodle soup, noodles, tofu brain, etc.

　　On the first day after operation, light diet should also be paid attention to to avoid eating different foods with high fat content, such as fried dough sticks, fat meat, mutton soup, chicken soup, rib soup, etc.

　　The aim of controlling the intake of fat cells is to reduce the risk of chylothorax.

　　After the second day of operation, they can gradually increase vegetable protein and fat food, without waiting for exhaust and defecation, but they should pay attention not to overeat.

　　Core content 4: Overcoming pain.

　　The pain of lung surgery mainly comes from incision and chest tube. Compared with other operations, the pain after lung surgery is severe. In addition to directly causing physiological damage, pain can also cause secondary emotional reactions, affecting cough, activities, diet, sleep, etc.

　　These secondary reactions will seriously affect the postoperative rehabilitation process. In order to facilitate the patient's recovery, pain can usually be reduced.

　　The anesthesiologist will prepare the analgesia pump for the patient, and the surgeon will also provide analgesia services by oral, external, intramuscular, intravenous infusion, etc.

　　Patients and their families often refuse to use painkillers for fear of affecting wound healing.

　　It should be noted that at regular doses, analgesics will not cause serious side effects, and there is no evidence that they will affect wound healing. When pain affects cough, activity, diet or sleep, it is recommended to give patients additional analgesic effect.

　　It should be noted that at the current medical level, no matter how many painkillers are added, it is difficult to be painless.

　　Therefore, patients should be taught to overcome mild pain, persist in coughing and activities, and strive to pull out the chest tube as soon as possible.

　　After the chest tube is pulled out, the pain will be obviously relieved. This is a virtuous circle. On the contrary, it will fall into a vicious circle of pain, no exercise, no removal of chest tube, and continuous pain.

　　To sum up, active cough, active activity, diet control and pain overcoming are the four core contents of rehabilitation after pneumonectomy.

　　The practice of these four cores and the strengthening of rehabilitation exercise can promote the rapid rehabilitation of lung surgery patients.

Shandong Zhushi Pharmaceutical Group Co., Ltd., founded in 2003, has more than 5000 registered employees. After years of development, it has developed into a diversified industrial cluster integrating medical devices, polymers, cosmetics, health food, daily necessities and biological reagent production, enterprise management consulting and training, real estate economy, pharmaceutical transportation, pharmaceutical printing, etc.

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