Lobectomy is lighting - this is an operation on excision of an anatomical lobe of the respiratory body. Such surgical intervention is carried out exclusively within the anatomical boundaries. Lobectomy is considered a rather complicated and risky operation, but in some cases it is the only way out to save the human life. Before conducting the operation, the patient comprehensively examines, since the patient's health is presented fairly high demands. This is associated with high traumatic and fairly long rehabilitation period.

Testimony

Remove part of the lung only in the presence of serious readings. The main indications for such an operation are:

Most often, the lobectomy of the lung is performed with the launched forms of tuberculosis and with tumors. With oncological diseases, during surgery, not only the share of the respiratory organ is removed, but also breast lymph nodes are excised.

Recently, small-acting operations are increasingly carrying out that allow a relatively small incision to extract part of the lung. Especially common operations with the use of electronmose and laser, although experienced surgeons often resort to freezing.

If the area of \u200b\u200bthe lesion is too extensive, then the resection of the roiber and the pericardia zone may be needed.

Preparation for lobectomy

The preparation for the operation is needed only by the patients who have a lot of purulent fluid or which are too pronounced intoxication. By any ways you need to ensure that the volume of exhaust sputum is about 60 ml per day. The body temperature and blood formula should also be within the normal range.

In addition, the doctor must have a bronchial tree rehabilitation with endoscopy. At the same time remove the pus and washed with antibacterial drugs and antiseptics. It is very important that the patient fed well and made breathing gymnastics.

The probability of complications in the postoperative period is significantly reduced if the doctor succeeds to achieve a dry bronchial tree. If the operation is performed by a patient with tuberculosis, then anti-tuberculosis therapy should be carried out in parallel.

The patient in front of the lobectomy is fully examined. It is unacceptable to carry out surgical interference during the exacerbation of chronic diseases or in infectious pathologies of a general nature.

Features of the performance of lobectomy

Removal of the lung lobe spend through a cut, which is made closest to the heart rate. Distinguish such types of access:

• Advanced. In this case, the surgeon makes a cut between the third and fourth edge, from the sternum to the back of the axillary depression.
• Side. The patient is placed on a healthy side and perform a neat incision from the region of the clavicle, to the vertebral region. Access is made at 5-6 ribs.
• Posterior. Such a cut is performed from the middle of the third or fourth breast vertebra to a corner of the blade, after which an incision is made along the line of the sixth edge to the front of the armp.

At certain cases, to achieve the focus of inflammation, you have to delete small areas of the Ryube. With the development of medicine, it became possible to carry out thoracoscopic operations. In this case, the doctor makes three small cuts with a long about 2 cm and one size of 10 cm. Through these cuts in the pleural area, surgical instruments are gently introduced. The frequency of negative consequences after this kind of operations is lower than in classical surgical intervention.

After the opening of the breast, the doctor finds out a large vessel and bronchus, which are then carefully tied. Initially, the surgeon processes the vessels, and after the bronchus. This uses a medical thread or bronighting agent. After the preparatory manipulations of the bronchus are covered with pleural, and the proportion of the lung is removed.

After the lobectomy, it is very important to straighten the remaining parts of the lung during the period of operation. For this purpose, the respiratory organs are filled with oxygen under high pressure. During the recovery period after operation, the patient will have to perform special breathing exercises to straighten all parts of the lung.

After the lobectomy conducted to the pleural cavity, drainages are deficiently inserted to remove the exudate. When the upper share of the top is removed, several drainage tubes are inserted, while removing the lower part of the lung is enough just one drainage.

Postoperative period

After the operation for several days, it is necessary to monitor that exudate, blood and air are freely separated through drainage tubes. If the operation passed without complications, the air ceases to go out already in the first hours, and the volume of the exhaust fluid is no more than 500 ml. Patients are allowed to sit on the second day, and get out of bed on the third day. After two weeks of the patient, they write out from the hospital to outpatient treatment.

Patients after transferred lobectomy it is recommended to regularly pass sanatorium treatment under dry climate conditions. Patients of young age can begin to work 2-3 months later, in the elderly patients on rehabilitation can take up to six months.

Mortality during and immediately after the operation is about 3%. Forecasts of life after removing benign tumors, both immediate and remote, very good. If the operation was carried out about tuberculosis, abscess or bronchiectases, then a positive result is observed by almost 90% of patients. The forecast for survival for patients with lung cancer is approximately 40%.

After the lobectomy, such a serious complication may occur as atelectaz lung.

When should I see a doctor

After lobectomy, it is necessary to urgently consult a doctor if there are such symptoms:

• The temperature rose, the chills appeared and the symptoms of general intoxication are observed.
• Postoperative seam blushed greatly, edema or began to root.
• If nausea is observed and vomiting a couple of days after discharge from the hospital hospital.
• If the pain with the operated side does not pass even after the admission of painkillers.
• If blood appeared in the urine or constant pain during urination is observed.
• Pains in the chest appeared, it became difficult to breathe or worried about his breath.
• If the cough is highlighted in a bloody or purulent mucus.
• If the overall health has deteriorated greatly.
• With the edema of the limbs.

It is urgent to cause ambulance with a strong chest pain and if the breath has become very difficult.

To avoid complications in the postoperative period, the patient needs to go home a lot, avoid lifting weights and carefully follow the cleanliness of the seam. The doctor will tell you how to properly care for the seam, how to swim and what kind of day the day is to stick. In the recovery period, the patient's nutrition must be rational. The menu should have many fresh vegetables and fruits, as well as dairy products. Do not forget to take drugs that were spelled out by the attending physician.

Breathing Even in healthy elderly people weakened physiologically due to age-related changes in the mucous membranes of the bronchi and reduce the volume of the lungs. When there is also a severe disease to the age-related changes, the human generating almost all the time is added, the breathing deteriorates even more, which leads to chronic oxygen starvation of the brain.

The respiratory gymnastics for lying patients becomes the same important component of treatment and rehabilitation, as well as prescribed by the doctor drugs: the success of the recovery and speed of further recovery depends on it.

Five reasons why gymnastics is needed

1. Prevention of blood stagnation in lungs and pneumonia

The first after the bronchi from the shortage of natural ventilation begin to suffer light. This is due to the redistribution of blood flow in the direction of the upper stakes and the dorsal zones of the lungs, which further provokes the development of stagnation of blood up to the occurrence of stagnant pneumonia - a formidable complication that often ends tragically.

2. Warning of breathing muscles

Due to forced long lying in the elderly, the muscles of the diaphragm, intercostal and peritoneal muscles weaken. This entails the omission of internal organs, which becomes the culprit of their squeezing, circulatory disorders and in the end - the beginning or aggravation of many other diseases.

3. Prevention of constipation and urinary incontinence

Breathing shortage is always a consequence of the absence or minimum of movement. The smaller the person moves, the worse his intestine works, whose motorika directly depends on the overall motor activity. The muscles of the bladder and the small pelvis are also weakening from the lack of physical movements, even if there is no coarse lesion of the brain.

Increasing intoxication due to the impossibility in time to derive livestock products or the lack of monitoring of departures is even more aggravated by an independent position. Therefore, respiratory gymnastics for lying patients in a complex with physical exercises is a necessary condition for maintaining in the norm of an excretory system of the body.

4. Beneficial effect on the nervous system

Insufficient breathing is superficial, shallow sleep, apnea, daily drowsiness, irritability. A person who is elementary is not poured, with difficulty performs even the most effective exercises to strengthen memory, shallow motility, speech: he just does not have the strength.

The tired, weakened person more often happens jumps of pressure and heart attacks - the main culprits and.

5. Strengthening immunity, good mood

Strong immunity \u003d good mood and vitality. If a person breathes badly, he is not up to therapy and rehabilitation programs: it would not be difficult to suffocate.

The respiratory gymnastics for lying patients makes it possible to keep and expand the existing volume of the lungs, timely saturation of the brain oxygen, muscle tone. Good breathing is calm, and therefore the team of the immune system: life - continues!

The immune system continues to control all the most important needs of the body: it is aware of the need for itself. While I breathe - I live!

When do you need respiratory gymnastics?

Always - even if the elderly person is healthy enough. But the greatest need for it occurs in diseases limiting mobility:

• Insults
• Infarcs
• Spinal injuries or limbs
• Severe course and other diseases affecting motor activity
• and other manifestations of dementia
• Surgical interventions, for a long time affecting the ability to breathe independently and move: resections of the gallbladder, kidney operations and other

Five exercises for self-execution

Professional breathing exercise cycles for lying patients - the task of rehabilitologists, but there are several types of tasks that are quite feasible and at home, with the help of and under the supervision of relatives or nurses:

• 1. Just raise your arms in turn - smoothly in turn or at the same time. Raise - inhale, lowering - exhale
• 2. Simultaneous raising hands. Similarly: when picked up, inhaling, when lowering hands - exhale
• 3. If there is a possibility at least a few minutes to sit: the hands are in the belt, the elbows are discharged to the maximum possible distance back. Inhale - and return starting position
• 4. lie on the stomach and stretch your hands ahead
• 5. From this provision, the assistant (relative, nurse, the regulator of the LFC) carefully folds hands on the elbows and defits them several times ago

Regularity and multipleness are important here: one or two times per day or a couple times a week is not enough. Such complexes are performed at least five times a day, ideally every two or three hours before sleep. An hour after a meal is a taboo for any exercises until food digested.

And what if an elderly person is so bad that he cannot perform the simplest exercises? At least just every hour turn it onto the right or left side: the main thing is not to give him all the time lying on the back. Then, over time, he will be available to their hands, legs - everything comes gradually.

Description of the main techniques of respiratory gymnastics

The most famous, productive and most frequently used respiratory gymnastics techniques for lying elderly, - by and.

Butyko method

It is based on breathing control by muscle relaxation. Daily classes teach to breathe slower, less and only nose. Initially, the control measurement is performed - the time in the second arrow, the time during which a person exhausted is capable of maintaining the following inhalation.

The arrows readings say this is what:

• Pause between inhams nose - 40 seconds and more, pulse - 70: everything is in order
• Pause at 20-40 seconds, pulse - 80: the first stage of the disease
• Pause at 10-20 seconds, pulse - 90: the second stage of the disease

If the pause fails to hold and ten seconds, according to the method of Buteyko, it corresponds to the third stage of the disease.

Training gradually increase the interval between the breath and exhalation, and the breath itself makes "economy": the attacks of the lack of air arise more and less. This allows in the future not only to reduce dosages used for the treatment of respiratory failure of drugs, but sometimes they completely refuse them.

Method Strelnikova

It is somewhat different from the Butyko method: there is no need to learn to detain the breath. A.N. Strelnikova, the author of this gymnastics, spoke only about the need for a sharp, short nasal breath and a silent exhalation of his mouth.

The breathing exercises in the technique are combined with physical: some movements of the limbs and body must match the breath, others - exhale. For example, the exercise "hike shoulders" compresses the chest - it is required to be performed on inhale.

Other well-known exercises of the techniques of Strelnoye - "Padoshki", "Steps", "Molders" - you need to do, alternating breath through the nose with exhale through the mouth. Each is performed on eight and at least 4 times. In the future, with improved well-being, the number of approaches increases - up to 12 and even 24 times.

Many restrictions include significant disadvantages of the method. The exercises of gymnastics Strelnikoy will have to select very carefully, to minimize and carefully monitor well-being, if an elderly person has:

• Hypertonic disease
• Epilepsy
• Heart disease or he recently suffered a heart attack
• Shainian Osteochondrosis, other spinal pathology and joints
• Urolithiasis disease

Both techniques are successfully used both at home and in hospitals and geriatric centers.
The result is already the first course of classes become:

• Improving breathing as such by the normalization of pulmonary ventilation, bronchi drainage, subsorative or disappearance of inflammatory and adhesive processes
• Strengthening muscle body and diaphragm
• Improving cardiac activity
• General strengthening the body

In addition to breathing exercises in Buteyko and Strelnoye, the restoration of normal respiration provides several exotic Chinese gymnastics, but they can only be recommended to those older people who are not immobilized.

Finally

Breathing is a movement. Give your native person to move, at least performing the simplest exercises. For small always comes great - just be patient and consistent: a reward for it will be a return to one degree or another of the full feeling of life in an elderly person.

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Memo patient after prompt intervention in the lungs

It is necessary to stop smoking tobacco. Smoking is very harmful for any person, but especially for those who have suffered an easy operation. It is not easy to get rid of nicotine addiction. And if it is impossible to abandon this disastrous habit of will, then you should seek help. Perhaps it will be a treatment with a psychotherapist, needleflexotherapy, coding. But the goal should be achieved
In addition, you should avoid staying in a dusty and tanned atmosphere, inhalation of poisonous and potent substances. It is useful to install air ionizers in the dwelling.
Large doses of alcohol oppress their breath and reduce the protective forces of the human body.
Alcohol is reduced to 30 ml of pure ethanol for men, up to 10 ml per day for women and faces with low body weight. If the patient has alcoholic lesions of the liver, the heart, the nervous system, it is necessary to categorically refuse to eat alcoholic beverages.

Power after operation on light

For the restoration of the body after an operation on light food should be full, easily digested. Food must be present vitamins, vegetables, fruits and juices.
The obligatory demand for nutrition is the restriction of the cook salt. Sodium chloride consumption should not exceed 6 g per day.
The patient after an operation on an easy operation should be supported by the body mass index (BMI) at the level of 18.5-24.9 kg / m2. The body mass index can be calculated by the formula:

BMI \u003d body weight / growth in meters 2

It is impossible to increase body weight, and patients with excessive body and obesity must necessarily lead their weight to normal. It is very important!!! Excessive body weight significantly increases the load on the lungs and the heart, and, therefore, increases the shortness of breath.
For patients undergoing light operation, exercise has a special meaning. They will develop compensatory (backup) capabilities of the remaining light and cardiovascular system. The body will be easily accustomed to work in new conditions and a person will return to active life.
Active physical exercises cannot be performed by patients with shortness of breath, pronounced decrease in hearing and vision, engine disorders, as well as during the exacerbation or appearance of acute infectious diseases (flu, colds, the aggravation of bronchitis, lung inflammation).
Physical training should be regular and long. The positive effect of physical exercise disappears after 3 weeks after their termination. Thus, the introduction of physical exertion in the lifelong program of conducting patients after an easy operation is mandatory.
Exercise can perform all patients after surgery without restriction of age and gender on the background of selected treatment with medication.

The physical exertion should be stopped:

Pronounced fatigue
Strengthening shortness of breath
Pain in calf muscles
Sharp reduction and enhancement of blood pressure
Sensation of heartbeat
The appearance of stunned pain
Pronounced dizziness, noise and pain in the head.

In order to normalize the tone of the smooth muscles of the bronchi, there is a respiratory gymnastics with the pronunciation of sounds.

1. After a moderate breath on a slow exhaler, squeeze the chest in the middle and lower departments, pronouncing the sounds "PF, RPR, Brok, Droch, Drahch, Brochh". Especially long to exhale the sound "PP". The output with each sound exercise should be repeated 4-5 times, gradually increasing with the number of repetitions to 7-10 times. The duration of the exhalation in the stopwatch should be at the beginning of 4-5 seconds, gradually reaching 12-25 seconds.
2. The same exercises can be performed using a towel. Towel is sinking the chest. At the slow exhalation, the towels squeeze the chest and pronounce the sounds listed above (6-10 times).
3. From the source position, half-sidia after a moderate breath on a slow exhale alternate pulling to the abdominal and thoracic wall. After each exhalation it follows a superficial breath.

After 1-2 months of regular occupations aimed at strengthening respiratory muscles. When performing exercise, burden is introduced.
An important component of physical exercise is relaxation.
Relaxation starts from the muscles of the legs, then consistently go to the muscles of the hands, chest, neck. Exercises on the relaxation of muscles of hands, legs, chest, neck perform in the sitting and standing position. In the future, the patient's attention is fixed on the fact that the muscles. Do not take part in performing this exercise should be relaxed. Each procedure of therapeutic gymnastics ends with general muscle relaxation.

Medical preparations

It is very important to follow the full span of sputum. To this end, you can take medicinal herbs (breast fee, BUB, Sporty, etc.) and expectorant drugs under the control of the attending physician. Parts of patients suffering from bronchitis with impaired bronchial patency requires drugs expanding bronchi. This treatment should also be under the control of the medical worker.
It is very important to effectively treat the existing diseases of the cardiovascular system, such as arterial hypertension, ischemic heart disease, blood circulation deficiency.
Almost all patients after an easy operation should take medicines fitting the work of the heart in new conditions. However, tips on the selection of medicines and control over their action should carry out the attending physician.

How to reduce shortness of breath?

Try to quit a crit. Smoking continues the irreversible aging of the remaining lung, and also increases the risk of heart attack and stroke.
Follow the good wet spill.
Follow the mass of your body.
Reduce the use of salt to a minimum.
Regularly engage in moderate exercise at least 20 minutes three times a week. Suitable walking walking, swimming, cycling.
Do not exceed the alcohol rate per day (30 ml of pure ethanol for men, up to 10 ml per day for women and faces with low body weight).
Each day leave the time to go dry.

When should I refer to the doctor without delay?

If the body temperature has appeared and purulent springs are cleared.
If a blood admixture appeared in sputum.
If the shortness of breath is over and is not reduced by the usual, helping previously.
If a sharp decline or an increase in blood pressure appeared.
If the stipulated pains appeared or frequent.

Operational treatment of chronic lung diseases (bronchiectatic disease, abscesses, chronic destructive tuberculosis) are used in their unsuccessful conservative treatment. Operational interventions on the lungs are also used in benign and malignant tumors. During operation, segmentectomy, lobectomy or pulmonectomy.
Radical operations on the lungs cause deep changes in the body due to the operating injury and a decrease in the respiratory surface. When removing the lobe of the lung, especially after the pulmonectomy, there are new conditions of hemodynamics due to the exception of a small circle of blood circulation. The sharp increase in the pulse and shortness of breath indicate a high degree of voltage of the compensatory forces of the body aimed at reducing phenomena of pulmonary and pulmonary-seemer deficiency. The development of compensation processes in light operations depends on the state of healthy light, chest excursion, the state of the CNS, which also suffers as a result of circulatory disorder and respiration. Pulmonary complications (pneumonia, atelectasis) dramatically worsen the state of the patient in the postoperative period, and sometimes the cause of death is caused.
The success of radical operations in the lungs largely depends on the functionality of the patient's body, the ability to mobilize compensatory forces to overcome disorders arising during surgery and in the postoperative period. It is clear that one drug therapy in the preoperative period cannot fully stimulate the compensatory possibilities of the organism and ensure the preparation of the patient to the operation. Among the measures that activate adaptive processes and increase the body's resistance in the diseases of the lungs, the physical regiment plays an important role.

The main tasks of the LFC in the preoperative period are directed to the following:
- reduction of purulent intoxication;
- increasing the functional state of the CSS;
- improvement of external respiratory function;
- strengthening the physical forces and nervous psychic status of the patient;
- assimilation of the exercises required by the patient in the early postoperative period;
- Strengthening the muscular system and especially the muscles involved in the act of breathing.
Much attention during preoperative preparation should be paid to improving ventilation indicators, a decrease in which may be a consequence of a decrease in the functioning pulmonary tissue, blockage of the main bronchine tumor, violations of bronchiol or lesions of the light purulent process.
Contraindications to the purpose of the exhibition of LFC in the preoperative period are: pulmonary bleeding, abundant hemoplary (blood traces in sputum do not interfere with the purpose of the exhibition); Pronounced cardiovascular insufficiency, myocardial infarction or lung in acute period, high temperature (if it is not due to sputum delay).
Classes of medical gymnastics should be started in the first days after the patient's arrival in the clinic. From the first lessons, we must try to reduce purulent intoxication using exercises for this purpose, contributing to the wet outflow from bronchiectatic cavities and abscess cavities. During this period, about 60-70% of the exercises should be aimed at improving the drainage function of the bronchial tree, the increase in sputum outflow. Patients, highlight a large amount of sputum, it is recommended to perform exercises aimed at drainage of bronchi, up to 8-10 times a day: in the morning before breakfast for 20-25 minutes, then 2 hours after breakfast, after a day of rest, every hour before dinner and For an hour before bedtime. The nature of the drainage exercises, as well as the corresponding initial position of the body of the patient with their implementation, is determined by localization and the degree of propagation of the purulent process.
Attention should be paid to training in patients of deep diaphragmal respiration with an emphasis on an elongated and enhanced exhalation.
Later, after a decrease in the daily amount of sputum and the amount of sputum separated during drainage exercises, a decrease in intoxication, improving the overall state of the patient, in the procedure of therapeutic gymnastics increases the proportion of overall and special exercises. Special exercises are directed to the activation of the backup capabilities of the cardiorespiratory system, the formation of compensation, ventilation improvement, an increase in the aperture mobility, learning a full breath, an increase in the strength of the respiratory muscles. The patient teach deeply breathing through the nose, perform a complex of exercises of the early postoperative period. Static and dynamic breathing exercises are used, exercises for localized breathing, exercises for all muscle groups without objects and with objects, gaming. Considerable attention is paid to the breathing training when walking first on the flat terrain, and then - when climbing the stairs. Patients must learn to control the breath during exercise, which requires coordination. All types of load associated with effort elements (throw the ball, tilt the torso, etc.), should be performed during exhalation.
Before the pulmonectomy, patients perform a complex of special respiratory exercises aimed at activating reserves of predominantly healthy lung.
Approximate complex of exercise in front of the pulmonectomy
one . I. p. - lying on a sore side on a solid roller (in order to limit the mobility of the chest sore side). Raising the hand up, take a deep breath, on a slow exhale to tighten the leg to the chest, bent in the knee joint (in the exhalation, the chest is compressed by the thigh, and on the side - with hand, due to which the exhale is maximum).
2. I. p. - the same, on the side surface of the chest bag with sand (1.5-2 kg). Raise your hand up, trying to breathe deeper and lift the bag with sand as much as possible. On the exhalation, lowering the hand on the chest, make a slow exhalation.
3. I.p. - lying on the back, the bag with sand - the hypochondrium of a healthy side. At inhalation, lift the bag as high as possible, on the exhalation - to lower with the help of the hands.
four . I. p. - on the sore side on the solid roller. Raising the hand up, deep forced breath, lowering the hand on the side surface of the chest, shoulder and forearm sharply press on the side surface of the chest, helping the forced exhale.
five . I. p. - Sitting on a chair, the sore side is fixed with a sick or instructor hand, a hand with a healthy side is removed to the side. After a deep forced breath, make a sharp slope in the sip of side on the forced exhale.
6. I. p. - Same. Take a hand with a healthy side to the side, making a deep breath. On the exhalation (slow or forced, depending on what state is the patient and the task should be solved), tilt the torso forward, getting a sock on the sore side.
7. I.p. - lying on the sick side on the roller, the hand from a healthy side is bent in the elbow joint. After a deep breath on the exhalation of the patient, rotational movements in the shoulder joint first in one, then to the other side.
LFC Tasks in the postoperative period:
- prevention of pulmonary complications (atelectasis, pneumonium);
- prevention of phlebotrombosis, pleural battles;
- the maximum development of compensatory lung and CCC capabilities;
- restoration of bronchial patency, fragrances of the lungs, which remained after partial resection;
- Prevention of disorders from the gastrointestinal tract (Parakes of the stomach and intestines, stool delay, meteorism, etc.);
- prevention restriction of mobility in the shoulder joint on the operated side, disorders of the posture and deformation of the chest;
- preparation of patients to expand the mode of motor activity;
- increase the tone of the nervous system.
Contraindications for therapeutic gymnastics: general heavy condition due to complications during surgery (shock, cessation of cardiac activity, large blood loss, etc.), significant hemoptysome, presence of bronchial fistula, spontaneous pneumothorax, high temperature, increasing subcutaneous emphysema, significant mediastinal displacement, secondary Bleeding or danger of its occurrence, frequent and small pulse at low maximum AO (below 90-100 mm Hg. Art.), Heavy acute respiratory and cardio-free failure, eliminates the possibility of additional physical exertion; Disorders of coronary or cerebral circulation.
Therapeutic gymnastics in the absence of complications are prescribed a few hours after surgery and are carried out according to the designated strict bed, advanced bed, treatment or free motor regime corresponding to the 1 -4th phases of compensation and the functional capabilities of physiological systems (V. V. Klapchuk). The compensation phases differ from each other. The degree of functional activity of physiological systems of the organism, the nature and amount of use of compensatory reactions, and therefore each phase corresponds to a certain motor mode.
In the first hours after operation, patients are in a horizontal position. After decreasing the residual actions of the anesthesia and awakening in the absence of hypotension and symptoms of brain ischemia in the patient's head end of the bed gradually raise.
Strict bed mode is prescribed in the first hours after the operation. After 1-2 hours after the end of the anesthesia, exercises are recommended to help the patient to learn how to breathe correctly, facilitate the separation of mucus and sputums from the respiratory tract, improve the ventilation of the lungs, help the sputum of sputum and cause cough.
In the initial position lying on the back of the patient performs a diaphragmal breathing. On the exhalation, the LFC instructor slightly presses the upper abdominal quadrant closer to the operated side. At the end of the exhalation, the patient coughs, while one hand of the instructor is on the postoperative wound, the second - on the site of the opposition of the operated side. At the end of the first day, the patient can independently perform this exercise every half hour - an hour.
Breast respiration should be carried out with the help of an instructor, which at the end of the exhaust pressure on the chest of the patient synchronously with cough jesters and achieves sputum.
To improve peripheral blood circulation, elementary exercises in the distal limbs are performed. In the absence of contraindications to the middle or by the end of the first day, the head end of the bed is raised as much as possible, and the instructor conducts slow rotational movements in the shoulder joint of the patient on the side of the operation performed. All movements are performed on a slow exhale. Then the patient performs breathing exercises with expectoravia. After that, it is advisable to light hand massage and the entire shoulder belt. The load is gradually growing due to an increase in the number of exercises, amplitude of movements, changes in the initial positions. Classes are carried out 3-5 times a day.
In the absence of drainage (if the postoperative period proceeds without complications) from 2 to 3 days expand the motor regime. To activate the ventilation function, the operated light patient with an instructor (and then independently) returns to a healthy side (legs are tightened to the stomach) and performs dynamic breathing exercises, alternating abdominal breathing type with chest. The instructor or the patient itself supports the postoperative wound by hand, pressing the second hand when exhaling a diaphragm. In addition, to improve the airiness of the pulmonary fabric it is recommended to inflate rubber or polyethylene toys, cylinders to inflate rubber or plastic toys. From the initial position lying on the side it is advisable to carry out a back and chest massage (especially weakened patients) with elements of light stroking, vibration, tapping. Easy tapping and vibration are carried out on exhalation and at the time of shaking. Massage helps to remove sputum, increase the tone of the respiratory muscles, reflectically improves ventilation. Along with this, the massage of the lower extremities is recommended, movement in small muscle groups of hands and legs that improve peripheral blood circulation.
In order to activate the breath in a healthy lung, allow turns to the sore side, alternate tightening of the legs to the stomach. All movements are necessarily combined with breathing, their loads are performed on a slow exhale. In order to prevent contractures in the shoulder joint on the side of the operation, increase the amplitude of movements in the shoulder joint. From the initial position, sitting in bed patient with a healthy hand raises a hand from the sore side by moving it in horizontal and vertical planes. The patient independently performs dynamic breathing exercises at a slow pace (exhalation with exhaustion). If he moves well this load, then they allow "walking" lying on the back with the full amplitude of movements in the knee and hip joints, the leading of the upper and lower extremities (without breaking them away from bed).
On the 3 -4th day after surgery, in the absence of complications from cardiovascular and respiratory systems, the patient is translated to the ward mode. Assign the exhibition in the form of classes on therapeutic gymnastics, morning hygienic gymnastics, independent activities. You can perform exercise in the original position sitting on the chair. The patient is allowed to lower legs from the bed on the bench and perform some of the exercise from this source position, and then - in the initial position sitting on the chair. The 5th day of the patient is allowed to get up for 1-2 minutes (first with the help of an instructor), then walk the chamber and the corridor. The patient should be paid to maintaining the right posture. During this period, in order to further train the body, increase the amplitude of movements and the number of exercises, include special respiratory and overall exercises from a preoperative preparation complex, use gymnastic items.
In the first days after the assignment of the store, special attention should be paid to the massage of the lower limbs.
Free regime in the event of the postoperative period without complications lasts from the 8-11th day after the operation before discharge. The treatment of the previous mode is added to the treatment walking in the amount of 30 - 40 - minute walks 2-3 times a day at a slow and middle pace, lifting the stairs. The procedure of therapeutic gymnastics includes exercises for all muscle groups, which are performed mainly at an average pace, sitting and standing, without objects, and using items: a gymnastic stick, light-stuffed balls weighing up to 1 kg, etc. . It is allowed to include playing elements to increase the emotional tone.
The duration of the treatment gymnastics procedure in the first 2-3 days is 5-10 minutes, for 4-7 days - 10-15 minutes, in the last days of the patient's stay in the clinic - 15-20 minutes.
In the first days after the operation, classes are carried out individually, then with the adaptation of the body to the physical exercise and the absorption of patients with breathing exercises and exercises, increase the mobility of the hand on the operated side, the treatment gymnastics is carried out by groups of 2-3 people. If the patient is distinguished by 50-100 ml of sputum per day, then the procedure of therapeutic gymnastics starts with exercises that contribute to the drainage of the bronchi. These exercises are recommended to perform after surgery up to 5-6 times a day or more.
After the pulmonectomy, a less load mode of motor activity is shown than after removing one or two pieces of the lung.
After discharge, the patients who are fulfilled with lobectomy and pulmonectomy, continue to perform the complexes of physical exercises at home in the hospital, complementing their outdoor walks. After 2 months after discharge, you can swim in the pool, in an open reservoir at air temperature not lower than 23-24 ° C and water temperature 21-22 ° C. Unacceptable overheating and hypothermia. In the future, the gradual increase in the load should be monitored, consulting a physician from a doctor.
Patients with complicated postoperative course of the disease (the discrepancy of the seams, postoperative bleeding, the suppuration in the pleural cavity, subcutaneous tissue, etc.) therapeutic gymnastics are prescribed after the elimination of complications.

The LFC after surgery on the stomach and duodenum has certain features. This is due to the fact that surgery on the stomach and the duodenum is characterized by large in size by the operating section of the anterior abdominal wall, intense and long postoperative pain syndrome, the need to comply with the beddown in the first 3-4 days of the postoperative period. In addition, in the first 2-4 days of the postoperative period in the abdominal cavity, drainages usually remain. All this determines the specific specificization of the organization of conducting therapeutic physical education.

The LFC, after surgery on the stomach and duodenum, avoids the development of complications from the respiratory, urinary, digestive systems (alas, non-discovered), the frequency of which is directly related to the insufficient activation of patients. It is especially important to perform a complex of therapeutic physical culture after operations on the stomach and a duodenum in the elderly in the 1st day of the postoperative period.

LFK Physical Culture after surgery on the stomach and duodenum: General

LFC after surgery on the stomach and duodenum can be started 6-12 hours after the patient's awakening. When it is carried out (especially the first), it is necessary to take into account that in-depth breathing with the participation of the diaphragm sharply increases the pain in the field of postoperative wound. In this regard, breathing in the 1st day after the operation should be predominantly infant. Therefore, the first exercise of the LFC after surgery on the abdominal organs must begin with the development of breast breathing. In addition, in the initial complex of therapeutic physical education, the patient with the instructor performs exercises for the distal departments of the lower and upper extremities, performs rotary movements in the hip joint, repeating each exercise 3-4 times with pauses for recreation (if necessary). Every 20-40 minutes the patient makes 3-4 respiratory exercises (breathing in the breast type).

Note! Drainages (which, after surgery on the abdominal organs, usually deleted on the 3-5th day) at the time of the execution of the complex of the LFC after the operation on the stomach and the duodenum is overlapped and tested under the supporting bandage.

On the 2-3rd day after surgery on the stomach and duodenalist, the patient, holding a postoperative wound, performs a complex of medical physical education independently and more often. In addition, a breast massage is recommended with elements of stroking, rubbing, light vibration.

The LFC after surgery on the stomach and duodenalist on the 3-4th day includes national consensus and special exercises (for example, the preparation of a patient for the summary of the vessel). The patient should turn on side as often as possible. In this position, he makes a back massage 1-2 times a day. Also, with the help of personnel, the patient give an elevated position in bed, placing a pillow under the back or lifting the head end of the functional bed. The legs are bent in the knee joints, the roller is put under them. Starting from the 3rd day of the postoperative period, the patient sits, not lowering the legs from the bed, 5-10 minutes (3-5 times a day). In this position, it performs static and dynamic breathing exercises of the LFK complex after surgery. From the initial position of "lying" the patient commits "walking" lying, sliding feet in a mattress with a small amplitude of movements in the knee joints.

The LFK after surgery on the stomach and duodenum, the complex of which is appointed immediately after surgery, includes general consensus and special exercises and is performed 3-5 times a day, it is optimally prepared by the patient to perform therapeutic physical culture from the original position sitting with the beds-naked legs.

Sitting with a bed clouded with a bed with a smooth course of the postoperative period, the patient is allowed for the 4-5th day. With sufficient adaptation of the patient to the position "Sitting", into a complex of therapeutic physical culture after surgery on the stomach and duodenum includes exercises for the upper and lower extremities, tilts of the head and rotational movement by it, the body exercises (the tilting of the body should be carried out with great caution). Then it is allowed to get up, leaning at first hands about the back of the chair. After resection of the stomach and duodenal intestine, with good tolerance of the previous load, it is recommended to get up on 6-9 days.

The exercise after surgery on the stomach and duodenalist with patients of the branches of abdominal surgery is first carried out in the ward, in the initial position, sitting on the stool. In addition to the constructions, in the complex of classes include breathing exercises, exercises for strengthening the muscles of the abdominal press, to form a moving postoperative scar, proper posture, normalization of the intestinal function (prevention of adhesive disease).

The LFK after the operation on the stomach and the duodenum from the 9-10th day of the postoperative period is carried out in the hospital's healing hall. The focus is on the restoration of the diaphragmal respiration, so the LFC complex includes exercises to strengthen the muscles of the abdominal press, the correction of posture defects, use exercises with projectiles. The duration of the exercise of the exhibition after surgery on the stomach and duodenum is 20-25 minutes.

The complex of exercises for independent practicing physical education after surgery on the abdominal organs includes walking along the corridor and stairs (the lift on the stairs is doing in exhalation).

LFK After surgery on the stomach and duodenum, the patient is recommended to perform after extracting from the hospital. The load can be increased under the control of the physician doctors. Sports exercises (skiing, skating, swimming, rowing) can be included in classes 6-12 months after surgery.

LFK after surgery on the stomach and duodenum - contraindications to the appointment

Contraindications to the appointment of the LFC patients who suffered surgical intervention in the abdominal cavity, serve:

• common severe condition of the patient;
• persistent increase in body temperature up to 37.5-37.7 ° C;
• hazard of bleeding;
• expressed pain syndrome;
• clinic of the preserving passer of the intestine;
• resistant increase or decrease in blood pressure.

LFK after surgery on the stomach and duodenum: Approximate exercise complex (1-2 days)

1. Source position - lying on the back. Back and sole bending stop (6-8 times). Breathing arbitrary.
2. Source position - lying on the back. Flexing and extension of fingers of hand brush (6-8 times). Breathing arbitrary.
3. Source position - lying on the back. Bend your hands to the shoulders, the elbows to the side - inhale, lower your arms along the body - exhale (2-4 times).
4. Source position - lying on the back. Hands along the body, deploy palms up - inhale. Rimming hands forward - up, palm down, pull them out to the knees - exhale (2-4 times).
5. Source position - lying on the back. Make 2-3 calm breathy and relax.

LFK after surgery on the stomach and duodenum: Approximate exercise complex (3-5 days)

1. Source position - lying on the back. Bend hands to the shoulders, elbows to the side - inhale, lower your hands along the body - exhale (6-8 times).
2. Source position - lying on the back. Hands along the body, deploy palms up - inhale. Rimming hands forward - up, palm down, pull them out to the knees - exhale (6-8 times).
3. Source position - lying on the back. Alternate bending of legs with a sliding in bed (4-6 times). Breathing arbitrary.
4. Source position - lying on the back. Feet bent in the knees. Raise the right hand up - inhale; Relish the right hand to the left knee - exhale. Make the same left hand to the right knee (4-5 times).
5. Source position - sitting in bed, hands on the knees, not strain. Hands to shoulders, elbows to dilute on the sides - inhale, lower hands on your knees - exhale (4-5 times).
6. Source position - sitting in bed, hands on the knees. Hands forward - up - inhale, hands omit through the sides down - exhale (2-3 times).
7. Source position - sitting in bed, hands on the knees. Dilute your arms to the sides - inhale, hands on your knees, tilt the torso forward - exhale (3-5 times).
8. Source position - sitting in bed, hands on the knees. Head slopes to the right, left, forward, back, head rotation (8-10 times). Breathing arbitrary.
9. Source position - sitting in bed, hands on the knees. Relax, make 6-8 calm breaths.

Therapeutic physical culture after surgery on the stomach and duodenalist: approximate exercise complex (6-10 days)

1. Source position - sitting in bed, hands on the knees, not strain. Hands to shoulders, elbows to dilute on the sides - inhale, lower your hands on your knees - exhale (6-8 times).
2. Source position - sitting in bed, hands on the knees. Dilute your arms to the sides - inhale, hands on your knees, tilt the torso ahead - exhale (6-8 times).
3. Source position - sitting in bed, hands on the knees. Relish hands up, get up with bed - inhale. Sit - exhale (6-8 times). You can get up from bed with one hand for the back of the chair or the instructor's hand.
4. Source position - standing behind the back of the chair, legs on the width of the shoulders, hands to the shoulders. Rotation in the shoulder joints in the same side (10-15 times). Breathing arbitrary.
5. Source position - sitting on the edge of the chair. Leaning against the back of the chair, dilute the hands and legs to the side - inhale. Sit right - exhalation (6-8 times).
6. Source position - standing, hands on the belt. Circular motions to the pelvis. At the expense of 1-2-3-4 - in one, 5-6-7-8 - to the other side (10-20 times).
7. Source position - sitting on a chair, hands on the back of the chair. Alternate lifting legs forward - up, without leaning back (6-8 times). Breathing arbitrary.
8. Source position - standing, hands on the belt. At the expense of 1 - turn to the left, left hand to the side - inhale; At the expense of 2 - return to its original position - exhalation; At the expense of 3 - turn to the right, the right hand to the side - inhale; At the expense of 4 - return to the starting position - exhale (8-10 times).
9. Source position - standing behind the chair, hands on the back of the chair, legs together. Alternate feet toad (6-8 times). Breathing arbitrary.
10. Source position - standing, left hand on the stomach, right on the chest. At the expense of 1 - to make a nose inhale, belly forward; On account 2 - remove the belly - exhale (6-8 times). The pace is slow.

Note: Exercises No. 8.9 are performed, starting from the 8th day after the operation on the stomach and the duodenum.

Important! Exercises of the treatment of therapeutic physical education after the operation on the stomach and the duodenum, which are performed from the initial position "sitting" or "standing", can only be carried out in the presence of a supporting dressing or a special medical postoperative belt. Supporting bandage or belt wear and removed in the "lying" position, in exhale.

LFK after operations on the stomach and duodenum - Efficiency criteria

The effectiveness of the treatment of therapeutic physical education after the operation on the stomach and the duodenum can be judged by:

• decrease in meteorism;
• improving the intestinal motor function (regularly decorated chair);
• reduction of shortness of breath;
• reduction of the pulse rate during exercise;
• disappearance of inflammatory seal around the postoperative scar.