术前肺康复与肺癌切除术患者的胸部物理治疗：一项初步随机对照试验。

Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial.

机构信息

Universidade Federal do Ceará (UFC), Fortaleza, Brazil.

出版信息

Arch Phys Med Rehabil. 2013 Jan;94(1):53-8. doi: 10.1016/j.apmr.2012.08.206. Epub 2012 Aug 24.

DOI:10.1016/j.apmr.2012.08.206

PMID:22926460

Abstract

OBJECTIVE

To evaluate the effect of 4 weeks of pulmonary rehabilitation (PR) versus chest physical therapy (CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection.

DESIGN

Randomized single-blinded study.

SETTING

A teaching hospital.

PARTICIPANTS

Patients undergoing lung cancer resection (N=24).

INTERVENTIONS

Patients were randomly assigned to receive PR (strength and endurance training) versus CPT (breathing exercises for lung expansion). Both groups received educational classes.

MAIN OUTCOME MEASURES

Functional parameters assessed before and after 4 weeks of PR or CPT (phase 1), and pulmonary complications assessed after lung cancer resection (phase 2).

RESULTS

Twelve patients were randomly assigned to the PR arm and 12 to the CPT arm. Three patients in the CPT arm were not submitted to lung resection because of inoperable cancer. During phase 1 evaluation, most functional parameters in the PR group improved from baseline to 1 month: forced vital capacity (FVC) (1.47L [1.27-2.33L] vs 1.71L [1.65-2.80L], respectively; P=.02); percentage of predicted FVC (FVC%; 62.5% [49%-71%] vs 76% [65%-79.7%], respectively; P<.05); 6-minute walk test (425.5±85.3m vs 475±86.5m, respectively; P<.05); maximal inspiratory pressure (90±45.9cmH(2)O vs 117.5±36.5cmH(2)O, respectively; P<.05); and maximal expiratory pressure (79.7±17.1cmH(2)O vs 92.9±21.4cmH(2)O, respectively; P<.05). During phase 2 evaluation, the PR group had a lower incidence of postoperative respiratory morbidity (P=.01), a shorter length of postoperative stay (12.2±3.6d vs 7.8±4.8d, respectively; P=.04), and required a chest tube for fewer days (7.4±2.6d vs 4.5±2.9d, respectively; P=.03) compared with the CPT arm.

CONCLUSIONS

These findings suggest that 4 weeks of PR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity.

摘要

目的

评估 4 周的肺康复（PR）与胸部物理治疗（CPT）对肺癌切除患者术前功能能力和术后呼吸发病率的影响。

设计

随机单盲研究。

地点

一所教学医院。

参与者

接受肺癌切除术的患者（N=24）。

干预措施

患者被随机分配接受 PR（力量和耐力训练）或 CPT（肺部扩张呼吸练习）。两组均接受教育课程。

主要观察指标

PR 或 CPT 4 周前后的功能参数评估（第 1 阶段），以及肺癌切除术后的肺部并发症评估（第 2 阶段）。

结果

12 名患者被随机分配到 PR 组，12 名患者被随机分配到 CPT 组。CPT 组中有 3 名患者因癌症无法手术而未接受肺癌切除术。在第 1 阶段评估中，PR 组的大多数功能参数从基线到 1 个月均有所改善：用力肺活量（FVC）（1.47L[1.27-2.33L]与 1.71L[1.65-2.80L]，分别；P=.02）；预计 FVC 的百分比（FVC%）（62.5%[49%-71%]与 76%[65%-79.7%]，分别；P<.05）；6 分钟步行测试（425.5±85.3m 与 475±86.5m，分别；P<.05）；最大吸气压力（90±45.9cmH(2)O 与 117.5±36.5cmH(2)O，分别；P<.05）；最大呼气压力（79.7±17.1cmH(2)O 与 92.9±21.4cmH(2)O，分别；P<.05）。在第 2 阶段评估中，PR 组术后呼吸发病率较低（P=.01），术后住院时间较短（12.2±3.6d 与 7.8±4.8d，分别；P=.04），并且需要引流管的天数较少（7.4±2.6d 与 4.5±2.9d，分别；P=.03）与 CPT 组相比。