Comparação dos efeitos da fisioterapia convencional associada a treinamento muscular inspiratório com dispositivo eletrônico em pacientes submetidos à operação para revascularização do miocárdio, com circulação extracorpórea: ensaio clínico randomizado e controlado

Abstract

Background: Patients undergoing coronary artery bypass grafting with cardiopulmonary bypass, may present respiratory muscle dysfunction after surgery, increasing the incidence of pulmonary complications. Objective: Compare the effects of a conventional physiotherapy protocol associated with inspiratory muscle training using an electronic device in patients submitted to coronary artery bypass grafting with cardiopulmonary by-pass, for the following variables: peripheral and respiratory muscle strength, functional capacity, functional independence, and quality of life, from the hospitalization period to the follow-up of 30 and 90 postoperative days. Method: This was a randomized controlled clinical trial. Inclusion criteria were individuals with coronary artery disease, with elective indication for myocardial revascularization with cardiopulmonary bypass, age between 18 and 80 years old, male and female, who agreed to sign the Free and Informed Consent Form. Patients with cognitive or musculoskeletal impairment were excluded; also, patients who presented aneurysm or cardiovascular instability in the preoperative evaluation period and during the postoperative protocol and others who had already undergone cardiac surgery associated to myocardial revascularization. Seventy patients, aged between 44 and 78 years, were randomized into two groups, the control group with conventional physiotherapy and the intervention group with conventional physiotherapy associated with inspiratory muscle training by electronic device. Both groups performed the protocol twice a day from the first to the fifth day after the surgery. The patients were evaluated in 5 moments: M1: preoperative; M1 ": 30 minutes after the spontaneous breathing test, before extubation; M2: 5th day after surgery; M3: followup 30 days after the surgery and M4: follow-up 90 days after the surgery. In these evaluations, data were collected maximal inspiratory and expiratory pressures, palmar grip strength, global muscle strength by the Medical Research Council (MRC), six-minute walk test, and the patients also answered two questionnaires, the functional independence measurement and quality of life SF-36. For statistical analysis, Mann-Whitney test, Chi-square test and Fischer exact test were used for numerical and categorical variables, and Friedman and Dunn tests for numerical variables of the electronic device. For the analysis of the groups and moments, delta and analysis of variance were used for repeated measurements with transformation by stations, followed by the test of profile by contrasts. To evaluate the normality of the data the Shapiro-Wilk test was used. For correlation analysis, the Spearman correlation coefficient. Was used the level of significance p <0.05%. Results: In the intervention group, there was a statistically significant increase in functional capacity (p = 0.0192), as well as in quality of life in the functional capacity domain (p = 0.0079), both observed at follow-up 90 days after surgery. There was a negative correlation of weak to moderate intensity between maximal inspiratory pressure and the variable palmar grip strength of the dominant hand in both groups over time. Conclusion: Respiratory muscle training with an electronic device, associated with conventional physiotherapy, increased the functional capacity and quality of life of patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. However, it was not able to promote additional gains in respiratory muscle strength, in the patients evaluated.