基于短期住院的肺癌患者高强度肺部康复：是否可行且有效？
Short-term inpatient-based high-intensive pulmonary rehabilitation for lung cancer patients: is it feasible and effective?
作者信息
Zhou Kun, Su Jianhua, Lai Yutian, Li Pengfei, Li Shuangjiang, Che Guowei
机构信息
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Rehabilitation Department, West China Hospital, Sichuan University, Chengdu 610041, China.
出版信息
J Thorac Dis. 2017 Nov;9(11):4486-4493. doi: 10.21037/jtd.2017.10.105.
BACKGROUND
This study was conducted to develop a preoperative in-hospital short-term rehabilitation program for surgical lung cancer patients, and investigate its feasibility, potential cost benefit and effectiveness on outcome measures including reduction of postoperative pulmonary complications (PPCs) and postoperative length of stay.
METHODS
A 7-day inpatient-based high-intensive rehabilitation regimen was performed between March 01, 2014 and June 30, 2015. It was combined with inspiratory muscles training (IMT) and aerobic endurance training and was tested in an enriched cohort study with 939 lung cancer patients undergoing lobectomy in a regional thoracic unit.
RESULTS
Finally, 939 patients were divided into pulmonary rehabilitation (PR) group (n=197) and non-PR (NPR) group (n=742), according to whether they received the 7-day preoperative in-hospital systematic rehabilitation. The PR group had a shorter total length of stay (14.7±4.0 16.7±6.2 days, P<0.001) as well as postoperative length of stay (6.2±3.3 8.3±5.6 days, P<0.001) than the NPR group. Lower incidences of total PPCs (18.3%, 36/197 26.1%, 194/742, P=0.022), pneumonia (11.2%, 22/197 17.3%, 128/742, P=0.024) and atelectasis (6.6%, 13/197 12.3%, 91/742, P=0.038) were found in the PR group compared with NPR group. Meanwhile, a multivariable analysis of risk to PPCs, atelectasis and pneumonia, revealed that the PR intervention was the independent risk factor of the occurrence of the PPCs (OR =0.57, 95% CI: 0.47 to 0.93, P=0.033) and atelectasis (OR =0.49, 95% CI: 0.26 to 0.91, P=0.024).
CONCLUSIONS
The study showed the effectiveness of this systematic and high-intensive PR combining IMT and aerobic exercise in reductions of the length of stay and occurrence of PPCs without increase in in-hospital cost, suggesting the potential of this rehabilitation pattern as a practicable strategy performed preoperatively in surgical lung cancer patients.
背景
本研究旨在为肺癌手术患者制定术前院内短期康复计划，并探讨其可行性、潜在成本效益以及对包括降低术后肺部并发症（PPCs）和术后住院时间等结局指标的有效性。
方法
2014年3月1日至2015年6月30日期间实施了一项为期7天的基于住院患者的高强度康复方案。该方案结合了吸气肌训练（IMT）和有氧耐力训练，并在一项纳入939例在区域胸科单元接受肺叶切除术的肺癌患者的队列研究中进行了测试。
结果
最后，根据是否接受了为期7天的术前院内系统康复，将939例患者分为肺康复（PR）组（n = 197）和非肺康复（NPR）组（n = 742）。PR组的总住院时间（14.7±4.0对16.7±6.2天，P<0.001）以及术后住院时间（6.2±3.3对8.3±5.6天，P<0.001）均短于NPR组。与NPR组相比，PR组的总PPCs（18.3%，36/197对26.1%，194/742，P = 0.022）、肺炎（11.2%，22/197对17.3%，128/742，P = 0.024）和肺不张（6.6%，13/197对12.3%，91/742，P = 0.038）的发生率更低。同时，对PPCs、肺不张和肺炎的风险进行多变量分析显示，PR干预是PPCs（OR = 0.57，95%CI：0.47至0.93，P = 0.033）和肺不张（OR = 0.49，95%CI：0.26至0.91，P = 0.024）发生的独立危险因素。
结论
该研究表明，这种结合IMT和有氧运动的系统且高强度的PR在缩短住院时间和降低PPCs发生率方面有效，且未增加院内成本，提示这种康复模式作为肺癌手术患者术前可行策略的潜力。
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