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基于计算机断层扫描三维重建评估肺叶切除术后吸气肌训练的恢复效果

Evaluation of Recovery Efficacy of Inspiratory Muscle Training After Lobectomy Based on Computed Tomography 3D Reconstruction.

作者信息

Wang Ting, Li Fanfan, Wang Xiaolan, Sang Tingrui, Wang Min, Ma Xiaoli, Bao Juan, Ma Guojing, Wang Panpan, Yue Qin, Zhao Dan, Ma Minjie

机构信息

Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, China.

School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China.

出版信息

Respir Care. 2023 Dec 28;69(1):42-49. doi: 10.4187/respcare.11037.

Abstract

BACKGROUND

Progressive resistance inspiratory muscle training is the principle of inspiratory air-flow resistance loading training to restore diaphragm function, increase alveolar compliance, and further improve respiratory function. However, there is a lack of research on the effectiveness of progressive resistance inspiratory training in post-lobectomy rehabilitation and the accurate assessment of lung volumes.

METHODS

In this study, 79 subjects diagnosed with lung cancer and undergoing thoracoscopic lobectomy were retrospectively analyzed. The subjects were divided into a control group ( = 40) and an observation group ( = 39) according to the different training modalities. The control group received conventional respiratory training. The observation group received progressive resistance inspiratory muscle training based on conventional breathing training. The primary outcome indicators were the following: lung function and lung volume. The secondary outcome indicators were the following: the number of postoperative hospital days, duration of drain retention, and incidence of postoperative pulmonary complications.

RESULTS

Baseline data on age, sex, body mass index, smoking history, education level, underlying disease, type of pathology, lung cancer stages, surgical site, preoperative lung volume, and preoperative lung function were not statistically different between the 2 groups ( > .05). The subjects in the observation group had median (interquartile range [IQR]) lung volumes at 1 month after surgery (3.22 [3.12-3.37] L vs 3.14 [2.95-3.24] L; = .031), median (IQR) FEV (2.11 [1.96-2.21] L vs 2.01 [1.81-2.12] L; = .031), and mean ± SD peak expiratory flow (5.07 ± 0.62 L/s vs 4.66 ± 0.64 L/s; = .005) were higher than those in the control group. The median (IQR) postoperative hospital stays (5 [4-5] d vs 5 [4-6] d; = .030) and the median (IQR) chest drain retention times were shorter in the observation group versus the control group (74 [72-96] h vs 96 [84-96] h; = .02). There was no significant difference in the incidence of postoperative atelectasis (5.1% vs 10.0%; = .41) and pneumonia (7.7% vs 12.5%; = .48).

CONCLUSIONS

Progressive resistance inspiratory muscle training was effective in improving lung volume and lung function, and in reducing the length of hospital stay and chest drain closure time after lobectomy.

摘要

背景

渐进性抗阻吸气肌训练是通过吸气气流阻力负荷训练来恢复膈肌功能、增加肺泡顺应性并进一步改善呼吸功能的原则。然而,关于渐进性抗阻吸气训练在肺叶切除术后康复中的有效性以及肺容积的准确评估方面缺乏研究。

方法

本研究对79例诊断为肺癌并接受胸腔镜肺叶切除术的患者进行回顾性分析。根据不同的训练方式将患者分为对照组(n = 40)和观察组(n = 39)。对照组接受常规呼吸训练。观察组在常规呼吸训练的基础上接受渐进性抗阻吸气肌训练。主要结局指标如下:肺功能和肺容积。次要结局指标如下:术后住院天数、引流管留置时间以及术后肺部并发症的发生率。

结果

两组在年龄、性别、体重指数、吸烟史、教育程度、基础疾病、病理类型、肺癌分期、手术部位、术前肺容积和术前肺功能等基线数据上无统计学差异(P > 0.05)。观察组患者术后1个月的肺容积中位数(四分位间距[IQR])(3.22[3.12 - 3.37]L对3.14[2.95 - 3.24]L;P = 0.031)、FEV中位数(IQR)(2.11[1.96 - 2.21]L对2.01[1.81 - 2.12]L;P = 0.031)以及平均±标准差的呼气峰值流速(5.07±0.62L/s对4.66±0.64L/s;P = 0.005)均高于对照组。观察组的术后住院天数中位数(IQR)(5[4 - 5]天对5[4 - 6]天;P = 0.030)以及胸腔引流管留置时间中位数(IQR)短于对照组(74[72 - 96]小时对96[84 - 96]小时;P = 0.02)。术后肺不张的发生率(5.1%对10.0%;P = 0.41)和肺炎的发生率(7.7%对12.5%;P = 0.48)无显著差异。

结论

渐进性抗阻吸气肌训练在改善肺叶切除术后的肺容积和肺功能、缩短住院时间以及胸腔引流管拔除时间方面是有效的。

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