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[高强度术前康复对适合肺癌手术的慢性阻塞性肺疾病患者围手术期并发症的影响]

[Effect of A High Intensive Preoperative Rehabilitation on the Perioperative 
Complications in Patients with Chronic Obstructive Pulmonary Disease Eligible 
for Lung Cancer Surgery].

作者信息

Meng Shenglan, Yang Fan, Dai Fuqiang, Chen Shuang, Huang Chaoqiong, Tan Qunyou, Niu Huijun

机构信息

The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China.

出版信息

Zhongguo Fei Ai Za Zhi. 2018 Nov 20;21(11):841-848. doi: 10.3779/j.issn.1009-3419.2018.11.06.

Abstract

BACKGROUND

Chronic obstructive pulmonary disease (COPD) will reduce the cardiopulmonary function and increase perioperative risk. The aim of this study is to investigate the effect of preoperative short-term high intensity lung rehabilitation training on lung function and postoperative complications in patients with COPD who are eligible for lung cancer surgery.

METHODS

We analysis of 101 patients with COPD and a diagnosis of lung cancer, with 43 patients in pulmonary rehabilitation group and 58 patients in conventional group. The pulmonary function, postoperative pulmonary complications (PPCs) and length of stay (LOS) will be compared between the two groups, the lung function will be compared before and after the rehabilitation at the same time.

RESULTS

There were no significant difference between the two groups in general information, lung function before surgery, postoperative pulmonary infection [8 (18.6%) vs 17 (29.3%)], atelectasis [1 (2.3%) vs 1 (1.7%)], respiratory failure [1 (2.3%) vs 2 (3.4%)] and postoperative LOS [(8.93±3.78) d vs (9.62±3.98) d, P>0.05]. In the rehabilitation group, the FEV1 [(2.06±0.45) L vs (2.15±0.45) L, P<0.001] and PEF [(4.32±0.90) L/s vs (5.15±1.05) L/s, P<0.001) were higher, and PCO2 [(42.42±2.79) mmHg vs (41.58±2.98) mmHg, P=0.009] was lower after rehabilitation, significantly. The increase value of FEV1 in moderate to severe COPD group was higher than that of the mild COPD group after the rehabilitation [(0.16±0.05) L, 8.6% vs (0.06±0.05) L, 2.8%, P<0.001).

CONCLUSIONS

The short-term highly-intensity lung rehabilitation can improve lung function in lung cancer patients with COPD, and the improvement of pulmonary function in moderate to severe COPD patients is more obviously.

摘要

背景

慢性阻塞性肺疾病(COPD)会降低心肺功能并增加围手术期风险。本研究旨在探讨术前短期高强度肺康复训练对符合肺癌手术条件的COPD患者肺功能及术后并发症的影响。

方法

我们分析了101例诊断为肺癌的COPD患者,其中43例患者进入肺康复组,58例患者进入常规组。比较两组患者的肺功能、术后肺部并发症(PPCs)及住院时间(LOS),同时比较康复组患者康复前后的肺功能。

结果

两组患者的一般资料、术前肺功能、术后肺部感染[8例(18.6%)对17例(29.3%)]、肺不张[1例(2.3%)对1例(1.7%)]、呼吸衰竭[1例(2.3%)对2例(3.4%)]及术后LOS[(8.93±3.78)天对(9.62±3.98)天,P>0.05]差异均无统计学意义。康复组康复后第1秒用力呼气容积(FEV1)[(2.06±0.45)L对(2.15±0.45)L,P<0.001]和呼气峰值流速(PEF)[(4.32±0.90)L/s对(5.15±1.05)L/s,P<0.001]显著升高,二氧化碳分压(PCO2)[(42.42±2.79)mmHg对(41.58±2.98)mmHg,P=0.009]显著降低。康复后中重度COPD组FEV1增加值高于轻度COPD组[(0.16±0.05)L,8.6%对(0.06±0.05)L,2.8%,P<0.001]。

结论

短期高强度肺康复可改善合并COPD的肺癌患者的肺功能,且中重度COPD患者肺功能改善更明显。

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