Pehlivan Esra, Balcı Arif, Kılıç Lütfiye
Pulmonary Rehabilitation Center, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Apr 24;27(2):212-218. doi: 10.5606/tgkdc.dergisi.2019.16474. eCollection 2019 Apr.
This study aims to investigate the effects of shortterm intense pulmonary rehabilitation on respiratory function in patients with lung cancer who were defined as inoperable due to insufficient pulmonary reserve.
A total of 25 patients (24 males, 1 female; mean age 62 years; range, 50 to 72 years) who were histologically diagnosed as non-small cell lung carcinoma, considered functionally inoperable due to high risk of an estimated postoperative complication, and suitable for surgical resection according to tumor stage were included in the study. Patients received chest physiotherapy, self-walking and inspiratory muscle training for two weeks. The forced expiratory volume in one second, forced vital capacity, modified Medical Research Council dyspnea scale, six-minute walking distance, maximal inspiratory and expiratory pressures for respiratory muscle strength measurements, and predicted peak maximal oxygen consumption were examined.
After pulmonary rehabilitation, there was statistically significant improvement in the six-minute walking distance (53 m, p<0.001), dyspnea perception (p<0.001), maximal inspiratory pressure (12 cm HO, p<0.001), forced vital capacity (p<0.001), predicted forced expiratory volume in one second (%) (p=0.001), forced expiratory volume in one second (Δ forced expiratory volume in one second= 150 mL, p=0.001; Δ maximum value of forced expiratory volume in one second: 650 mL), and predicted maximal oxygen consumption (p<0.001). At the end of the rehabilitation, 60% of the patients (n=15) reevaluated by the surgeons could be operated.
Short-term intensive pulmonary rehabilitation improves lung functions and exercise capacity while decreasing dyspnea perception. In our study, thanks to the gains derived from the exercise, approximately more than half of the patients could be operated. Therefore, it may be useful to refer patients to rehabilitation before establishing a decision of inoperability.
本研究旨在调查短期强化肺康复对因肺储备不足而被定义为无法手术的肺癌患者呼吸功能的影响。
本研究纳入了25例患者（24例男性，1例女性；平均年龄62岁；范围为50至72岁），这些患者经组织学诊断为非小细胞肺癌，因预计术后并发症风险高而被认为功能上无法手术，但根据肿瘤分期适合手术切除。患者接受了为期两周的胸部物理治疗、自主行走和吸气肌训练。检测了一秒用力呼气量、用力肺活量、改良医学研究委员会呼吸困难量表、六分钟步行距离、呼吸肌力量测量的最大吸气和呼气压力以及预测的最大氧耗峰值。
肺康复后，六分钟步行距离（增加53米，p<0.001）、呼吸困难感知（p<0.001）、最大吸气压力（增加12厘米水柱，p<0.001）、用力肺活量（p<0.001）、预测的一秒用力呼气量（%）（p=0.001）、一秒用力呼气量（一秒用力呼气量增加150毫升，p=0.001；一秒用力呼气量最大值增加650毫升）以及预测的最大氧耗（p<0.001）均有统计学意义的改善。在康复结束时，经外科医生重新评估，60%的患者（n=15）可以进行手术。
短期强化肺康复可改善肺功能和运动能力，同时减轻呼吸困难感知。在我们的研究中，由于运动带来的改善，约一半以上的患者可以进行手术。因此，在做出无法手术的决定之前，将患者转诊至康复治疗可能是有益的。
