EVALUATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING

Abstract

Chronic obstructive pulmonary disease (COPD), a chronic disease resulting In airflow obstruction due to cigarettesmoking, sharing smoking as a central risk factor, COPD and ischaemic heart disease commonly co-exist.althought essential for the diagnosis Of COPD. The guidelines from The National Institute for clinical Excellence (NICE)2004 define COPD as characterized by air flow obstruction. The air flow obstruction is usually progressive over several months .COPD is a spectrum of disorder which include chronic bronchitis and emphysema. Spirometry is fundamental to making confidential diagnosis of COPD, it is a method of assessing lung function. • CABG is a very important operation to cororany artery disease patients; it is indication Classic III - IV angina: that is unresponsive to medical therapy. • Post-infarction angina: <2-4 weeks post-myocardial infarction. • Acute ischemia or haemodynamic instability following PTCA.(55) • Acute evolving infarction: within 6 hours of onset of pain with or without PTCA. The aim of this study is to assess spirometry criteria in COPD patients correlated with post CABG surgery and to detect post- CABG complication. A total of 100 male COPD patients were enrolled in the study. They were selected to perform Coronary Artery Bypass Grafting (CABG) at Nasser Institute Hospital. Informed consent was obtained from each patient. Pulmonary function measurements were performed, in a sitting position, preoperatively, on the 7th postoperative day with a Medical Pulmonary Function System (Spirometry). The highest value of two or three technically satisfactory maneuvers was retained for measurement of vital capacity (VC), inspiratory capacity (IC), and forced expiratory volume The result had proved that there is severe restrictive changesin pulmonary function test, there is marked decrease in FVC, FEV1 and PEF. The effect of CABG on COPD patient because of division of the sternum,Increase the degree of diaphragmatic dysfunction, impairment of pulmonary mechanics and gas exchange.Arterial hypoxemia normally occurs after CABG and persists for some weeks,The contact of the blood with the oxygenator triggers a cascade effect of enzymatic changes, with the release of inflammatory cytokines, increases in the permeability of the alveolar-capillary membrane, reducing blood-gas membrane,During CPB it is common to interrupt the pulmonary ventilation. Respiratory complications remain a leading cause of post cardiac surgical morbidity and can prolong hospital stays and increase costs. It includes pleural effusion, atelectasis, COPD acute Exacerbation, pneumonia, prolonged mechanical ventilation,ARDS and phrenic nerve injury. Pulmonary rehabilitation after coronary artery bypasses graftingshould be done to all patient after CABG, it includes early mobilization, Respiratory muscle training, Neuromuscular electrical stimulation and Breathing exercises.