快速康复外科在非小细胞肺癌患者围术期中的应用

Applied value of multimodai fast - track surgery programme in perioperation of lung surgery in non - small cell lung cancer patients

目的探讨快速康复外科（fast—track surgery，FTS）在非小细胞肺癌（nonsmall—cell lung cancer，NSCLC）患者围术期中的应用。方法2007年9月至2010年5月对40例NSCLC患者围术期采用FTS模式（PTS组）；同期40例按传统手术外科（conservative treatment surgery，CTS）围术期处理的同种手术患者（CTS组）作对照。比较两组患者术后肺部并发症（肺部感染、肺不张、持续漏气大于7d）的发生率；同时分析两组的心血管事件、外科技术并发症、术后辅助通气时间、手术结束时体温、ICU停留时间（length of stay，LOS）及住院天数等。结果两组患者的年龄、性别、术前肺功能（forced expiratory volume in one second, FEV1 ）以及美国麻醉学会（ American Society of Anethesiologists, ASA）评分等差异无统计学意义。FTS组术后早期肺功能（FEV1）恢复较CTS组快（P〈0．05），术后肺部并发症的发生率显著减少（34．21％比8．33％，P〈0．05）。两组LOS的中位数相差1d；FTS组住院天数明显低于CTS组，差异有统计学意义[（11．1±3．6）d比（16．6±5．7）d，P〈0．05]。结论FTS模式对NSCLC患者进行围术期处置，可减少术后肺部并发症等的发生率，促进患者早期康复。

Objective To investigate the applied value of a multimodal fast - track surgery （FTS） programme in perioperation of lung surgery in non- small cell lung cancer（NSCLC） patients. Methods Eighty patients who underwent radical pulmonary lobectomy surgical treatment for NSCLC were randomly assigned to either the FFS treatment（ n = 40, FTS group）or the conservative treatment surgery（CTS） regimen（n = 40, CTS group）respectively from September 2007 to May 2010. Study endpoints were pulmonary complications（ pneumonia, atelectasis, prolonged air leak）; Secondary endpoints were cardiovascular events and technical complication; Further parameters assessed in the postoperative course of patients were the need for postoperative mechanical ventilation, temperature at the end of the operation, length of stay （LOS） on intensive care unit（ICU） and hospital stay. Results Both study groups were similar in terms of age, sex, preoperative forced expiratory volume in one second （FEV1）and American Society of Anesthesiologists（ASA） score. The rate of postoperative pulmonary complications was 34.21% in CTS group and 8.33% in FTS group（P 〈 0. 05）. A subgroup of patients with reduced preoperative FEV1 experienced less pulmonary complications in FTS group（P 〈 0.05）. Median LOS on ICU was comparable in both groups（ 1 day）. Also the hospital stay was significantly different in both groups（ 11.1 ±3.6 d vs 16.6 ±5.7 days, P 〈 0.05）. Conclusion Our results support the implementation of an optimized perioperative treatment. Using this fast track lung surgery regimen clinical pathway may reduce pulmonary complications and accelerate recovery after lung cancer resection.