Estimulação diafragmática elétrica transcutânea (EDET) em mulheres obesas mórbidas submetidas à derivação gástrica em Y de Roux (DGYR) com anel de contenção, por laparotomia
Abstract
The bariatric surgery has been considered an effective procedure for
weight and co-morbidities reductions and consequently for the life quality
improvement. However, in the same way as all surgeries, it can bring complications
and alterations in the pulmonary function meanly in obeses. In this way, the objective
of this study was the evaluation of the pulmonary function, the respiratory muscular
strength and the thoracic mobility after the physiotherapy treatment with
transcutaneous electric diaphragmatic stimulation (TEDS) in patients submitted to
Roux-en-Y gastric bypass (RYGB) and the quality of their lives after the weight
reduction. Forty-four morbid obese women with BMI > 40kg/m2 were studied. The
Ethics Committee of Researches properly approved this study. The obese women
were evaluated through spirometry, manovacuometry and thoracic abdominal
cirtometry in the pre-operative period and fifteen and thirty days after the surgery ;
they were randomly separated into two groups of twenty-two each. The Control
Group (CG) was submitted to the conventional chest physiotherapy (CCP), while
Experimental Group (EG) was submitted to the conventional chest
physiotherapy associated with the TEDS (CCP+TEDS). The assessment of the life
quality occurred between the sixth and the sixteenth month of the post-operative
period by the BAROS questionnaire. To the statistics analysis was used GraphPad
InStat for Windows, 3.05 version, the test of Kolmorogov Smirnov, Friedman and
Mann-Whitney. It was considered significant p<0.05. To the data analysis of the
BAROS questionnaire, descriptive statistics tests like average, standard deviation,
absolute numeral values and percentage were used. The results showed that there
were no statistically significant differences to the flows and pulmonary volume
measurements and to the MIP (p>0.05). Related to the MEP, there was a
progressive and significant reduction from the pre to the thirty day after the surgery
for the CG, but not to the EG. It was observed that the alterations in the thorax
abdominal mobility were not significant to the CG in any evaluation. However, with
the EG, the differences were significant at the three moments of evaluations and to
the three evaluated locals. Finally, the result of the quality of life questionnaire
BAROS application showed that the bariatric surgery got satisfactory results to
2,27%, good to 9,10%, very good to 36,36% and excellent to 52,27% of the patients. Based on these results it is possible conclude that both CCP and (CCP)
associated with TEDS were effective in the maintenance of pulmonary flows and
volumes, of the capacity of muscle endurance, and the maintenance of the strenght
muscles at the post-operative period of the RYDG. However, the CCP associated
with the TEDS revealed to be much more effective not only to the maintenance of the
expiratory muscles strenght as to guarantee a greater thorax abdominal mobility by
increasing the muscle contraction. The loss of overweighting contributes to the life
quality improvement in morbid obese women.