• Korean Circulation Journal
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• 제53권6호
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• pp.406-417
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• 2023

Background and Objectives: Pathophysiological changes of right ventricle (RV) after repair of tetralogy of Fallot (TOF) are coupled with a highly compliant low-pressure pulmonary artery (PA) system. This study aimed to determine whether pulmonary vascular function was associated with RV parameters and exercise capacity, and its impact on RV remodeling after pulmonary valve replacement. Methods: In a total of 48 patients over 18 years of age with repaired TOF, pulmonary arterial elastance (Ea), RV volume data, and RV-PA coupling ratio were calculated and analyzed in relation to exercise capacity. Results: Patients with a low Ea showed a more severe pulmonary regurgitation volume index, greater RV end-diastolic volume index, and greater effective RV stroke volume (p=0.039, p=0.013, and p=0.011, respectively). Patients with a high Ea had lower exercise capacity than those with a low Ea (peak oxygen consumption [peak VO₂] rate: 25.8±7.7 vs. 34.3±5.5 mL/kg/min, respectively, p=0.003), while peak VO₂ was inversely correlated with Ea and mean PA pressure (p=0.004 and p=0.004, respectively). In the univariate analysis, a higher preoperative RV end-diastolic volume index and RV end-systolic volume index, left ventricular end-systolic volume index, and higher RV-PA coupling ratio were risk factors for suboptimal outcomes. Preoperative RV volume and RV-PA coupling ratio reflecting the adaptive PA system response are important factors in optimal postoperative results. Conclusions: We found that PA vascular dysfunction, presenting as elevated Ea in TOF, may contribute to exercise intolerance. However, Ea was inversely correlated with pulmonary regurgitation (PR) severity, which may prevent PR, RV dilatation, and left ventricular dilatation in the absence of significant pulmonary stenosis.

• Journal of Gastric Cancer
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• 제18권2호
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• pp.118-133
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• 2018

Purpose: Exercise intervention after surgery has been found to improve physical fitness and quality of life (QOL). The purpose of this study was to investigate the feasibility and effects of a postoperative recovery exercise program developed specifically for gastric cancer patients (PREP-GC) undergoing minimally invasive gastrectomy. Materials and Methods: Twenty-four patients treated surgically for early gastric cancer were enrolled in the PREP-GC. The exercise program comprised sessions of In-hospital Exercise (1 week), Home Exercise (1 week), and Fitness Improvement Exercise (8 weeks). Adherence and compliance to PREP-GC were evaluated. In addition, body composition, physical fitness, and QOL were assessed during the preoperative period, after the postoperative recovery (2 weeks after surgery), and upon completing the PREP-GC (10 weeks after surgery). Results: Of the 24 enrolled patients, 20 completed the study without any adverse events related to the PREP-GC. Adherence and compliance rates to the Fitness Improvement Exercise were 79.4% and 99.4%, respectively. Upon completing the PREP-GC, patients also exhibited restored cardiopulmonary function and muscular strength, with improved muscular endurance and flexibility (P<0.05). Compared to those in the preoperative period, no differences were found in symptom scale scores measured using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) and Quality of Life Questionnaire-Stomach Cancer-Specific Module (QLQ-STO22); however, higher scores for global health status and emotional functioning were observed after completing the PREP-GC (P<0.05). Conclusions: In gastric cancer patients undergoing minimally invasive gastrectomy, PREP-GC was found to be feasible and safe, with high adherence and compliance. Although randomized studies evaluating the benefits of exercise intervention during postoperative recovery are needed, surgeons should encourage patients to participate in systematic exercise intervention programs in the early postoperative period (Registered at the ClinicalTrials.gov, NCT01751880).

• Tuberculosis and Respiratory Diseases
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• 제50권4호
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• pp.401-408
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• 2001

연구배경 : 폐 절제술이 술후 운동능력의 변화에 어떤 영향을 주는지 잘 알려져 있지 않으나 폐 관류 검사를 이용하여 술후 운동능력을 예측하고자 하는 몇몇 연구들이 있었다. 그러나 이들 연구들은 검사시점 및 대상환자의 선정 등에 문제가 있음이 지적되고 있다. 본 연구에서 폐암 환자에서 술후 운동능력을 예측하는데 술전 폐관류 검사의 유용성 및 술전 후의 폐기능의 변화가 운동능력의 변화와 상관관계가 있는지를 알아보고자 하였다. 방 법 : 술전 1주 이내에 폐기능 검사, 심폐 운동부하 검사, technetium 99m labelled macroaggregated albumin (99mTc-MAA)을 이용한 폐 관류 겸사 및 체중, 체질량 지수를 측정하였다. 폐관류 검사를 이용한 술후 검사의 예측치는 preoperative values measured$\pm$[% perfusion remained/(% perfusion resected+% perfusion remained)]를 이용하여 구하였다. 폐관류 검사를 이용한 술후 검사치의 예측도를 알기 위하여 술후 실측된 검사치와 폐관류 검사로 예측한 검사치의 비[postoperative value measured/postoperative value predicted)$\pm$100%]를 구하였다. 또한 환자의 술전 후 각각의 실측된 검사치 간의 차이를 비교하기 위하여[(preoperative value measured-postoperative value measured)/preoperative value measured]$\pm$100%를 측정하였다. 결 과 : 대상군에서 술전 및 술후 6개월에 측정한 체중 및 체질량 지수의 차이가 없었다. 술후 실측된 $VO_{2max}$는 폐관류 검사에 의하여 예측된 $VO_{2max}$의 112%이었으며, $WR_{max}$는 119% 이었다. 그러나 술후 실측된 심폐 운동부하 검사치는 폐관류 검사에 의하여 예측된 심폐 운동부하 검사치와 각각 $r_s$, 값이 0.794와 0.932로 유의한 상관관계를 보였다. 심폐 운동부하 검사치에서는 전폐절제술 환7-r군에서 술후 실측된 $VO_{2max}$ 및 $WR_{max}$는 예측된 각각의 검사치의 121.05%, 136.51%이었으며, 엽절제술 환자군에서는 각각 107.94%와 111.59%이었다. 심폐 운동부하 검사치의 감소는 엽절제술 환자군에서 $VO_{2max}$와 $WR_{max}$가 각각 7.69%와 3.73%이었고 전폐절제술 환자군에서는 15.71%와 7.14% 었다. 술전 후 $FEV_1$, FVC 및 TLC의 변화는 술전 후 $VO_{2max}$와 $WR_{max}$의 변화와 유의한 상관관계를 보였다. 결 론 : 술전 폐관류 검사는 술후 운동능력을 예측하는데 유용하다고 판단된다. 그러나 술전 폐관류 검사는 술후 운동능력을 낮게 평가하는 경향을 보였다.

• Hip & pelvis
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• 제34권1호
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• pp.10-17
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• 2022

Purpose: This study was conducted in order to assess changes in hip muscles by comparing results of preoperative and postoperative computed tomography (CT) in older patients who underwent surgery for treatment of hip fracture. Materials and Methods: A total of 50 patients (aged ≥65 years) who underwent surgery for treatment of intertrochanteric fractures (25 patients) and femoral neck fractures (25 patients) between February 2013 and February 2019 and underwent preoperative and postoperative pelvic CT were enrolled in the study. The cross-sectional area, attenuation and estimates of muscle mass of the gluteus medius, gluteus minimus, iliopsoas, and rectus femoris on the uninjured side were measured. Basic patient data (sex, age, height, weight, body mass index [BMI], bone mineral density [BMD], Harris hip score [HHS], and length of follow-up) were collected from medical records. Results: No significant differences in sex, age, height, weight, BMI, BMD, HHS, and length of follow-up were observed between the two groups. No significant difference in the cross-sectional areas and attenuations of gluteus medius and gluteus minimus was observed after surgery; however, a statistically significant decrease was observed in those of iliopsoas and rectus femoris after surgery. Lower estimates with statistical significance of muscle mass of the iliopsoas and rectus femoris were observed on postoperative CT. Conclusion: Muscle mass of the hip flexor (iliopsoas, rectus femoris) showed significant decreases on postoperative CT compared with preoperative CT. Based on these findings, selective strengthening exercise for hip flexor should be beneficial in rehabilitation of hip fractures.

• 대한통합의학회지
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• 제11권2호
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• pp.23-35
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• 2023

Purpose : Lung cancer induces a decrease in physical activity and a deterioration of respiratory ability. Exercise is an effective treatment to reduce side effects of anti-cancer treatments, also influence the survival and successful rehabilitation in lung cancer patients. However, there is insufficient evidence to show which period is the most effective to apply exercise for lung cancer patients. Therefore, this study was conducted to evaluate the efficacy of exercise-based interventions before and after surgery. Methods : Clinical trials (CTs) and randomized controlled trials (RCTs) reported in PubMed database were investigated. The trials investigated in this study were published for 10 years before August 20, 2022. The risk of bias was judged according to the Cochrane guideline. The materials included in this meta-analysis were 6-minute walk test (6MWT), pulmonary function, and quality of life (QOL). Results : 1 CT and 9 RCTs were selected in current study. In the meta-analysis, exercise increased 6MWT in preoperation (mean difference [MD] 29.49; 95 % confidence interval [CI] .99 to 57.99; p=.04; I²=0 %), 3 months postoperation (MD 54.97; 95 % CI 31.85 to 78.09; p<.001; I²=45 %) and 6 months postoperation (MD 85.59; 95 % CI 45.06 to 126.12; p<.001; I²=47 %). Exercise, also enhanced the lung function such as FEV₁/FVC (%) in postoperation (MD 7.64; 95 % CI 6.26 to 9.02; p<.001; I²=19 %). Additionally, exercise improved QOL, such as preoperative EORTC-QLQ-C30-LC13 in mental function (MD 3.21; 95 % CI .64 to 5.79; p=.01; I²=0 %) and postoperative SF-36 in mental component summary (MD 9.24; 95 % CI 4.94 to 13.54; p<.001; I²=0%). Conclusion : These results indicate that exercise-based intervention can elevate the ability to exercise and the mental componentof QOL within 3 months.

• 종양간호연구
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• 제10권1호
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• pp.95-102
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• 2010

Purpose: The aim of this study was to evaluate the effect of a breathing exercise intervention by measuring pulmonary function test (PFT) three times; preoperative, 3rd and 5th day after operation. Methods: This study was designed as a non-equivalent control group pretest-posttest design. A total of 55 patients with lung cancer were recruited from a Chonnam university hospital in Hawsun-gun, Korea from January to December 2008. Results: 'Forced Vital Capacity (FVC)' and 'Forced Expiratory Volume in 1 second $(FEV_1)$' were significantly improved in the experimental group than those in the control group (p<.05). Conclusion: Breathing exercise intervention was found to be effective in improving pulmonary function among lung cancer patients underwent lung lobectomy. Thus, the breathing exercise can be applied in hospitals and communities for patients with lung cancer as one of the nursing intervention modalities for their better postoperative rehabilitation.

• 대한간호학회지
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• 제48권3호
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• pp.279-288
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• 2018

Purpose: The purpose of this study was to examine the effects of breathing exercises performed using panflutes in elderly patients undergoing spinal surgery. Methods: The study design was a nonequivalent control group non-synchronized pre-post test. The study included 24 patients in both the experimental group and the control group. The experimental group completed a daily breathing exercise regimen using panflutes for 30minutes after meals, whereas the control group was provided standard preoperative education, including breathing exercises using incentive spirometers. After the exercise regimen, breathing exercise compliance, pulmonary infections, and life satisfaction were measured in both groups, and the data were analyzed using the SPSS/WIN program. Results: The compliance rate of breathing exercises was significantly higher in the experimental group. The experimental group presented no pulmonary infections in the later period, whereas the control group presented higher pulmonary infection rates in the same period. In addition, the life satisfaction score in the experimental group significantly increased. Conclusion: The breathing exercise program using panflutes for elderly patients undergoing spinal surgery enhanced their breathing exercise compliance and their daily life satisfaction in addition to reducing their pulmonary infection rates.

• 한국간담췌외과학회지
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• 제26권4호
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• pp.375-385
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• 2022

Backgrounds/Aims: Prehabilitation aims for preoperative optimisation to reduce postoperative complications. However, there is a paucity of data on its use in patients undergoing pancreaticoduodenectomy (PD). Thus, this study aims to evaluate the outcomes of a home-based outpatient prehabilitation program (PP) versus no-PP in patients undergoing PD. Methods: This retrospective cohort study compared patients who underwent PP versus no-PP before elective PD from January 2016 to December 2020. Inclusion criteria for PP were < 65 years or 65-74 years with FRAIL score < 3. No-PP included dietician, case manager and anesthesia review. PP included additional physiotherapy sessions, caregiver training and interim phone consultation. Univariate and multivariate analysis were used to evaluate length of stay (LOS), morbidity, 30-day readmission, and 90-day mortality. Results: Seventy-one patients (PP: n = 50 [70.4%]; no-PP: n = 21 [29.6%]) were included in this study. Median age was 65 years (interquartile range [IQR]: 58-72 years). Majority (n = 58 [81.7%]) of patients underwent open surgery. Ductal adenocarcinoma was the most common histology (49.3%). Patient demographics were comparable between both groups. Overall median LOS was 11.0 days (IQR: 8.0-17.0 days). Compared to no-PP, PP was not independently associated with reduced intra-abdominal collections (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.03-6.11, p = 0.532), major morbidity (OR: 1.31; 95% CI: 0.09-19.47; p = 0.845) or 30-day readmission (OR: 3.16; 95% CI: 0.26-38.27; p = 0.365). There was one (1.4%) 30-day mortality. Conclusions: Our outpatient PP with unsupervised exercise regimes did not improve postoperative outcomes following elective PD.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1146-1151
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• 1990

Supravavular aortic stenosis is a congenital narrowing of the ascending aorta just distal to the level of the origins of the coronary arteries, that may be localized or diffuse. Five patients with supravalvular aortic stenosis were operated upon between July, 1986 arid June, 1990. Four of these patients were William`s syndrome [mental retardation, elfin face], and one was isolated supravalvular aortic stenosis. Preoperative diagnosis of the supravalvular aortic stenosis was made by left side cardiac catheterization and angiocardiography. There are three types of supravalvular aortic stenosis such as membranous, hourglass and hypoplastic. Four of our patients were of hourglass type, and one was hypoplastic type. Patch aortoplasty was performed in all cases. Preoperative systolic gradients ranged from 45 to 1SO mmHg [average 102.6 mmHg]: postoperative gradients ranged from 0 to 75 mmHg [average 39 mmHg]. The patient of hypoplastic type has been suffered from mild exercise intolerance even after the operation, and the postoperative echocardiography revealed the systolic gradient of 100 mmHg [preoperative 180 mmHg]. The results of surgery for hourglass type were excellent. But the patient with hypoplastic form would be benefited from some modifications of the operation.

• 대한간호학회지
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• 제44권4호
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• pp.381-390
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• 2014

Purpose: The purpose of this study was to identify the effects of a Progressive Walking program (PW) on physical activity, exercise tolerance, recovery, and post-operative complications for patients with a lung resection. Methods: A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection (22 for control group, 15 for experimental group) were recruited at A university hospital from December 2012 to August 2013. The PW consisted of preoperative education, goal setting, and feedback, provided to the experimental group, and usual care to the control group. Data were analyzed using the SPSS WIN 18.0. Results: A higher proportion of patients in the experimental group showed adequate levels of physical activity (p=.001), shorter period of chest tube retention (${\leq}7$ days; p=.011), and shorter stay in the hospital (${\leq}10$ days; p=.036) than patients in the control group. Patients in the experimental group reported longer 6-minute walking distance (p=.032) and lower levels of dyspnea (p=.049) than patients in the control group. The PW did not influence the occurrence of pulmonary complications. Conclusion: The findings of this study suggest that the PW could be a useful strategy for improving patients' post-operative health and reducing cost after lung resection.