第一临床医学院知识库

目的:探讨术前肺康复训练对于胸腔镜肺叶切除肺癌患者的影响。方法:回顾性分析我科2014年1月-2017年3月连续64例胸腔镜肺叶切除的肺癌患者临床资料，其中术前肺康复训练患者（Preoperative Pulmonary rehabilitation PR）和未行康复训练患者（Non-preoperative Pulmonary rehabilitation NPR）各32例,分别对比两组患者术后住院时间、胸管拔除时间、肺不张发生率、再次胸腔穿刺率、术后肺部并发症发生率以及PR组训练前后的肺功能、动脉血气分析及登楼测试参数。  

结果;PR组共有32例行术前肺康复训练，与NPR组相比，PR组术后住院时间短[（8.56±2.20）d vs.（12.41±2.51）d，t=-6.512 ，P=0.000]，术后肺部并发症发生率低[18.75%（6/32）vs.43.75%（14/32），c²=4.655，P=0.031]，肺部感染及肺不张发生率低[12.5%（4/32）vs.34.4%（11/32），c²=4.267，P=0.039；12.5%（4/32）vs.37.5%（12/32），c²=20.536， P=0.000]，胸管拔除早[（5.41±1.72）d vs.（9.28±2.71）d，t=-6.821 ，P=0.000]，但再次胸腔穿刺率[9.37%（3/32）vs.28.13%（9/32），c²=3.692， P=0.055]无统计学差异。PR组训练前后登楼时间T（49.87±8.32s vs. 47.78±8.20s，t=9.647 ，P=0.000）、 Borg指数（6.75±2.02 vs. 5.09±1.53，t=8.128 ，P=0.000）改善均有统计学差异，而登楼前后心率改变ΔP（49.73±7.97次/分vs. 50.03±8.07次/分，t=-1.075，P= 0.291）、血氧饱和度百分比改变ΔSPO₂%（5.25±2.53% vs. 4.21±2.03%，t=1.568 ，P= 0.127）无统计学差异。PR组训练前后肺功能参数FEV₁（2.11±0.42L vs. 2.15±0.37L）、FVC（2.89±0.54L vs. 2.75±0.38L）、FEV1/FVC（73.52±7.91 vs. 77.64±12.48 ）、MVV（87.77±20.06L/min vs. 87.33±15.22 L/min）、DLCO（7.48±1.54 mol/min/Kpa vs. 7.63±1.23 mol/min/Kpa）、动脉血气分析SPO₂（60.53±4.83mmHg vs. 62.24±5.31 mmHg）、PaCO₂（38.38±3.24 mmHg vs. 39.19±2.92 mmHg）变化均无统计学差异（P＞0.05）。PR组术后30天无死亡病例发生，NPR组术后1例因肺栓塞死亡。结论:对胸腔镜肺叶切除肺癌患者，术前1周的肺功能康复训练可以明显缩短术后住院时间，降低术后肺部并发症，减少术后带管时间，提高胸腔镜肺叶切除患者手术的耐受力,可以根据不同单位的实际情况进行推广开展。

ObjectiveTo explore the effect of preoperative pulmonary rehabilitation in patients with lung cancer undergoing video-assisted thoracoscopic lobectomy.MethodsA retrospective analysis of our hospital of 64 consecutive cases of video-assisted thoracoscopic lobectomy for lung cancer patients with clinical data from January 2014 to May 2017, including preoperative pulmonary rehabilitation (PR group) and non-preoperative Pulmonary rehabilitation of patients (NPR group) of the 32 cases, respectively, corresponding respectively to compare two groups of patients in length of postoperative stay, chest tube removal duration, the incidence of atelectasis, pleural puncture rate again, postoperative pulmonary complications and the pulmonary function, arterial blood gas analysis and stair-climbing test were taken before and after the training of PR group.

ResultsThere were 32 cases of preoperative pulmonary rehabilitation, compared with the NPR group, the mean postoperative length of stay [(8.56 + 2.20) d vs. (12.41 + 2.51) d, t=-6.512, P=0.000], the incidence of postoperative pulmonary complications [18.75% (6/32) vs.43.75% (14/32), c²=4.267, P=0.031],pulmonary infection[12.5% (4/32) vs.34.4% (11/32), c²=4.267, P=0.039],atelectasis [12.5% (4/32) vs.37.5% (12/32), c²=20.536, P=0.000],and chest tube removal duration [(5.41 + 1.72) d vs. (9.28 + 2.71) d, t=-6.821, P=0.000] were significantly reduced in the PR group.Hever, there was no significant difference in pleural puncture again [9.37% (3/32) vs.28.13% (9/32), c²=3.692 P=0.055]. Stair climb time T (49.87 + 8.32s vs. 47.78 + 8.20s, t=9.647, P=0.000),and Borg index (6.75 + 2.02 vs. 5.09 + 1.53, t=8.128, P=0.000) were statistically significant difference in PR group before and after training. But the change of heart rate and heart P (49.73±7.97time/min vs. 50.03±8.07 time/min,t=-1.075, P= 0.291) and oxygen saturation percentage change ΔSPO₂% (5.25±2.53% vs. 4.21±2.03%,t=1.568 ,P= 0.127) had no significant difference. In PR group before and after training ,there was no significant difference in FEV₁(2.11 + 0.41L vs. 2.29 + 0.51L), FVC (2.89 + 0.54L vs. 2.75 + 0.59L), FEV₁/FVC (74.88 + 9.10 vs. 76.87 + 6.70), MVV (87.77±20.06 L/min vs. 87.33±15.22 L/min), DLCO (7.48±1.54 mol/min/Kpa vs. 7.63±1.23 mol/min/Kpa), SPO₂(60.53±4.83 mmHg vs. 62.24±5.31 mmHg), PaCO₂(38.38±3.24 mmHg vs. 39.19±2.92 mmHg). No deaths occurred in the PR groups at 30 days after operation,In PR group, one patient died in pulmonary embolism.

ConclusionFor lung cancer patient undergoing video-assisted thoracoscopic lobectomy, pulmonary rehabilitation program lasting 4 weeks was considered may be shorten postoperative length of stay, reduce postoperative pulmonary complications, decrease postoperative intubation time, improve thoracoscopic lobectomy patients tolerance, and can be used to carry out according to the actual situation of different units.