Vagvolgyi Attila, Rozgonyi Zsolt, Kerti Maria, Vadasz Paul, Varga Janos
Department of Thoracic Surgery, National Koranyi Institute for Pulmonology and Semmelweis University, Budapest, Hungary.
Central Department of Anaesthesiology and Intensive Care, National Koranyi Institute for Pulmonology, Budapest, Hungary.
J Thorac Dis. 2017 Jun;9(6):1584-1591. doi: 10.21037/jtd.2017.05.49.
Functional condition is crucial for operability of patients with lung cancer and/or chronic respiratory diseases. The aim of the study was to measure changes of functional and quality of life parameters in terms of the effectiveness of perioperative pulmonary rehabilitation (PR).
A total of 208 COPD patients (age: 63±9 years, man/woman: 114/94, FEV1: 62±14%pred) participated in a perioperative PR program. The indication was primary lung cancer in 72% of the patients. The 68 patients participated in preoperative (PRE) rehabilitation, 72 in a pre- and postoperative rehabilitation (PPO) and 68 patients only in postoperative rehabilitation (POS). PR program included respiratory training techniques, individualized training and smoking cessation. Lung function tests, 6 minutes walking distance (6MWD) were measured before and after the rehabilitation. Quality of life tests [COPD Assessment Test (CAT) and Modified Medical Research Council Dyspnoea Scale (mMRC)] were evaluated as well.
There was a significant improvement in FEV1 (PRE: 64±16 67±16%pred; PPO: 60±13 66±13%pred before the operation, 48±13 52±13%pred after the operation; POS: 56±16 61±14%pred, P<0.05) and 6MWD (PRE: 403±87 452±86 m; PPO: 388±86 439±83 m before, 337±111 397±105 m after the operation; POS: 362±89 434±94 m, P<0 0001). Significant improvement was detected in FVC, grip strength, mMRC and CAT questionnaires as an effectiveness of PR, also. Average intensive care duration was 3.8±5.2 days with 3.1±3.6 without preoperative PR.
Improvements in exercise capacity and quality of life were seen following PR both before and after thoracic surgery.
功能状态对于肺癌和/或慢性呼吸道疾病患者的可手术性至关重要。本研究的目的是根据围手术期肺康复（PR）的有效性来测量功能和生活质量参数的变化。
共有208例慢性阻塞性肺疾病（COPD）患者（年龄：63±9岁，男/女：114/94，第1秒用力呼气容积（FEV1）：62±14%预计值）参与了围手术期PR计划。72%的患者的适应症为原发性肺癌。68例患者参与了术前（PRE）康复，72例参与了术前和术后康复（PPO），68例患者仅参与了术后康复（POS）。PR计划包括呼吸训练技术、个体化训练和戒烟。在康复前后测量肺功能测试、6分钟步行距离（6MWD）。还评估了生活质量测试[慢性阻塞性肺疾病评估测试（CAT）和改良医学研究委员会呼吸困难量表（mMRC）]。
FEV1有显著改善（PRE：64±16→67±16%预计值；PPO：术前60±13→66±13%预计值，术后48±13→52±13%预计值；POS：56±16→61±14%预计值，P<0.05）和6MWD（PRE：403±87→452±86米；PPO：术前388±86→439±83米，术后337±111→397±105米；POS：362±89→434±94米，P<0.0001）。作为PR有效性的结果，在用力肺活量（FVC）、握力、mMRC和CAT问卷方面也检测到显著改善。平均重症监护持续时间为3.8±5.2天，未进行术前PR的为3.1±3.6天。
在胸外科手术前后进行PR后，运动能力和生活质量均有改善。
