肺康复对肺手术患者运动能力、健康相关生活质量及心肺功能的影响：一项回顾性倾向评分匹配分析
Impact of pulmonary rehabilitation on exercise capacity, health-related quality of life, and cardiopulmonary function in lung surgery patients: a retrospective propensity score-matched analysis.
作者信息
Niu Chunlai, Lin Huan, Zhang Zinan, Wang Qing, Wei Yingjun
机构信息
Department of Respiratory and Critical Care Rehabilitation, Shanghai Second Rehabilitation Hospital, Shanghai, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
出版信息
Front Med (Lausanne). 2024 Aug 12;11:1450711. doi: 10.3389/fmed.2024.1450711. eCollection 2024.
BACKGROUND
Pulmonary rehabilitation is considered beneficial for patients undergoing lung surgery, yet its specific impacts on exercise capacity, health-related quality of life (HRQL), and cardiopulmonary function require further elucidation. This study aimed to evaluate the effect of PR on these outcomes in patients undergoing lung surgery using a retrospective propensity score-matched analysis.
METHODS
We retrospectively analyzed 420 patients with non-small cell lung cancer (NSCLC) who underwent lung surgery from January 2022 to May 2024. Among these, 84 patients received PR while 336 did not (control group). Propensity score matching (PSM) at a 1:1 ratio yielded 46 patients in each group. Baseline characteristics, spirometry, cardiopulmonary exercise testing, respiratory muscle strength, HRQL, and muscle measurements were assessed pre-and post-surgery.
RESULTS
Before PSM, significant differences existed between groups, with the PR group being older and having different pulmonary function baselines. After PSM, groups were well-balanced. Postoperatively, the PR group showed significant improvements in FEV1/FVC (64.17% vs. 50.87%, < 0.001), FEV1 (2.31 L/min vs. 1.75 L/min, < 0.001), and predicted FVC percentage (88.75% vs. 68.30%, < 0.001). Cardiovascular responses showed a lower CI during exercise in the PR group post-PSM (6.24 L/min/m vs. 7.87 L/min/m, < 0.001). In terms of exercise capacity, the PR group had higher maximal WR percentage (104.76% vs. 90.00%, = 0.017) and peak VO2 (1150.70 mL/min vs. 1004.74 mL/min, = 0.009). PR also resulted in less leg soreness and lower total CAT scores postoperatively. Muscle measurements indicated significantly smaller reductions in ΔHU and percentage change in the PR group.
CONCLUSION
Pulmonary rehabilitation significantly enhances exercise capacity, HRQL, and cardiopulmonary function in patients undergoing lung surgery. It also mitigates postoperative muscle loss, underscoring its importance in the postoperative management of lung surgery patients.
背景
肺康复被认为对接受肺部手术的患者有益，但其对运动能力、健康相关生活质量（HRQL）和心肺功能的具体影响仍需进一步阐明。本研究旨在通过回顾性倾向评分匹配分析评估肺康复对接受肺部手术患者这些结局的影响。
方法
我们回顾性分析了2022年1月至2024年5月期间接受肺部手术的420例非小细胞肺癌（NSCLC）患者。其中，84例患者接受了肺康复，336例未接受（对照组）。按1:1比例进行倾向评分匹配（PSM）后，每组有46例患者。在手术前后评估基线特征、肺功能测定、心肺运动试验、呼吸肌力量、HRQL和肌肉测量。
结果
在PSM之前，两组之间存在显著差异，肺康复组年龄较大且肺功能基线不同。PSM后，两组达到良好平衡。术后，肺康复组的FEV1/FVC（64.17%对50.87%，<0.001）、FEV1（2.31L/min对1.75L/min，<0.001）和预计FVC百分比（88.75%对68.30%，<0.001）有显著改善。心血管反应显示，PSM后肺康复组运动期间的心脏指数较低（6.24L/min/m对7.87L/min/m，<0.001）。在运动能力方面，肺康复组的最大WR百分比更高（104.76%对90.00%，=0.017），峰值VO2更高（1150.70mL/min对1004.74mL/min，=0.009）。肺康复还导致术后腿部酸痛减轻，总CAT评分降低。肌肉测量表明，肺康复组的ΔHU减少和百分比变化显著更小。
结论
肺康复显著提高了接受肺部手术患者的运动能力、HRQL和心肺功能。它还减轻了术后肌肉损失，突出了其在肺部手术患者术后管理中的重要性。
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