Shi Qingtong, Diao Yali, Qian Jun
Department of Thoracic Surgery, the Affiliated Hospital of Yangzhou University, Yangzhou 225000, China.
Department of Thoracic Surgery, Yancheng First People's Hospital, Yancheng 224000, China.
Zhongguo Fei Ai Za Zhi. 2020 Aug 20;23(8):667-672. doi: 10.3779/j.issn.1009-3419.2020.101.26. Epub 2020 May 21.
Lung cancer is currently the leading malignant tumor in both domestic and foreign morbidity and mortality. Surgical treatment is the main treatment option for lung cancer. The aim of this study is to explore the effects of enhanced recovery after surgery (ERAS) combined with respiratory function exercise combined with single-hole thoracoscopic surgery on lung cancer patients with postoperative pulmonary complications, postoperative pain, time to get out of bed, time to extubation and length of hospital stay.
A total of 240 patients who underwent endoscopic lung cancer surgery at the Affiliated Hospital of Yangzhou University and the Yancheng First People's Hospital from October 2017 to October 2019 were randomly divided into 4 groups, with 60 patients in each group. Patients in group A underwent single-hole thoracoscopic surgery, and preoperatively performed ERAS concept education and respiratory function training; group B used conventional 3-hole thoracoscopic surgery, and performed ERAS concept education and respiratory function training before operation; group C used conventional 3-hole thoracoscopic operation surgery, routine hospitalization education and nursing guidance, routine respiratory function training, no preoperative ERAS concept education; group D used single-hole thoracoscopic surgery, routine hospitalization education and nursing guidance, routine respiratory function training, no preoperative ERAS concept mission. The number of postoperative pulmonary complications, postoperative pain, time to get out of bed, extubation time, and hospital stay were recorded in the four groups.
Compared with the groups B, C, and D, the incidence of pulmonary complications was significantly reduced, and the time to get out of bed, extubation time, and hospital stay were significantly shortened in group A. Compared with groups B, C, the postoperative pain was significantly reduced in group A. Compared with group C, the pulmonary complications were significantly reduced, and the time to get out of bed, extubation time and hospital stay were significantly shortened in group B. The differences were statistically significant (P<0.05). There was no significant difference in postoperative pain between group A and group D, group B and group C (P>0.05).
For patients with single-hole thoracoscopic lung cancer surgery, the ERAS concept guidance can effectively reduce the incidence of pulmonary complications and postoperative pain, shorten the time to get out of bed, the time to extubate, and the length of hospital stay.
肺癌是目前国内外发病率和死亡率最高的恶性肿瘤。手术治疗是肺癌的主要治疗方式。本研究旨在探讨术后加速康复（ERAS）联合呼吸功能锻炼结合单孔胸腔镜手术对肺癌患者术后肺部并发症、术后疼痛、下床时间、拔管时间及住院时间的影响。
选取2017年10月至2019年10月在扬州大学附属医院和盐城市第一人民医院行内镜下肺癌手术的240例患者，随机分为4组，每组60例。A组患者行单孔胸腔镜手术，术前进行ERAS理念教育及呼吸功能训练；B组采用传统三孔胸腔镜手术，术前进行ERAS理念教育及呼吸功能训练；C组采用传统三孔胸腔镜手术，进行常规住院教育及护理指导，常规呼吸功能训练，术前未进行ERAS理念教育；D组采用单孔胸腔镜手术，进行常规住院教育及护理指导，常规呼吸功能训练，术前未进行ERAS理念宣教。记录四组患者术后肺部并发症发生情况、术后疼痛程度、下床时间、拔管时间及住院时间。
与B、C、D组相比，A组肺部并发症发生率显著降低，下床时间、拔管时间及住院时间显著缩短。与B、C组相比，A组术后疼痛显著减轻。与C组相比，B组肺部并发症显著减少，下床时间、拔管时间及住院时间显著缩短。差异均有统计学意义（P<0.05）。A组与D组、B组与C组术后疼痛比较，差异无统计学意义（P>0.05）。
对于行单孔胸腔镜肺癌手术的患者，ERAS理念指导可有效降低肺部并发症发生率及术后疼痛程度，缩短下床时间、拔管时间及住院时间。
