Huang Jian, Lai Yutian, Zhou Xudong, Li Shuangjiang, Su Jianhua, Yang Mei, Che Guowei
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Rehabilitation Department, West China Hospital, Sichuan University, Chengdu 610041, China.
J Thorac Dis. 2017 Jul;9(7):1919-1929. doi: 10.21037/jtd.2017.06.15.
The feasibility and practicality of preoperative rehabilitation (PR) programs remains quite controversial in the treatment of lung cancer (LC). This study explored whether a short-term high-intensity rehabilitation program could improve postoperative outcomes compared to those achieved with conventional inspiratory muscle training (IMT).
A three-armed randomized controlled trial comparing the two training modalities and routine care was conducted in surgical LC patients. Patient groups received one of three treatment regimens: (I) high-intensity pulmonary rehabilitation (PR) that combined IMT with conventional resistance training (CRT) (combined PR group); (II) conventional PR (single IMT group); or (III) routine preoperative preparation (control group). The primary endpoint was a change in the occurrence of post-operative pulmonary complications (PPCs) that occurred within 30 days after surgery, while secondary endpoints included changes in length of hospital stay, quality of life (QoL) scores, 6-min walk distance (6-MWD) and peak expiratory flow (PEF).
A total of 90 enrolled patients were randomized into three groups with a computer-based 1:1:1 ratio. The intention-to-treat analysis of the study revealed that, compared with the Control Group, the Combined PR Group had a significant increase in 6-MWD (by 32.67 m, P=0.002), PEF (by 14.3 L/min, P=0.001), global scores (by 3.7, P=0.035); and a reduced average total hospital stay (by 3.2 d, P=0.001) and ∆postoperative stay (by 3.6 d, P=0.001). With regard to PPC rate, the Combined PR Group had a somewhat lower PPC severity (grade II-V) compared to the Control Group.
This hospital-based short-term program of PR combining high-intensity IMT with CRT was significantly superior to the conventional IMT program, indicating that this approach would be a feasible strategy for treating LC patients, especially those waiting operations with surgery-related risk factors.
术前康复（PR）计划在肺癌（LC）治疗中的可行性和实用性仍存在很大争议。本研究探讨了与传统吸气肌训练（IMT）相比，短期高强度康复计划是否能改善术后结局。
对接受手术的LC患者进行了一项三臂随机对照试验，比较两种训练方式和常规护理。患者组接受三种治疗方案之一：（I）将IMT与传统阻力训练（CRT）相结合的高强度肺康复（PR）（联合PR组）；（II）传统PR（单一IMT组）；或（III）常规术前准备（对照组）。主要终点是术后30天内发生的术后肺部并发症（PPCs）的发生率变化，次要终点包括住院时间、生活质量（QoL）评分、6分钟步行距离（6-MWD）和呼气峰值流量（PEF）的变化。
总共90名入组患者以基于计算机的1:1:1比例随机分为三组。该研究的意向性分析显示，与对照组相比，联合PR组的6-MWD显著增加（增加32.67米，P = 0.002），PEF显著增加（增加14.3升/分钟，P = 0.001），总体评分显著增加（增加3.7，P = 0.035）；平均总住院时间缩短（缩短3.2天，P = 0.001），术后住院时间缩短（缩短3.6天，P = 0.001）。关于PPC发生率，联合PR组的PPC严重程度（II-V级）略低于对照组。
这种基于医院的将高强度IMT与CRT相结合的短期PR计划明显优于传统IMT计划，表明这种方法将是治疗LC患者，特别是那些具有手术相关危险因素的等待手术患者的可行策略。
