术前肺康复对肺癌合并中-重度慢性阻塞性肺疾病患者运动耐力的影响

Effect of Preoperative Pulmonary Rehabilitation on Exercise Capacity of Lung Cancer Patients with Moderate or Severe Chronic Obstructive Pulmonary Disease

目的评估术前肺康复(PR)对肺癌合并中-重度慢性阻塞性肺疾病(COPD)患者运动耐力的影响。方法选择2009年3月至2010年8月华西医院胸外科收治32例肺癌伴中-重度COPD患者作为研究对象,其中30例完成术前为期2周的肺康复训练并接受手术治疗,男18例,女12例;年龄62.5±7.7岁。中度COPD 12例,重度COPD 18例;康复前后均进行心、肺功能评估,并分析这些患者的术后肺部并发症发生情况及住院时间。结果 (1)静态肺功能试验中第1秒用力肺活量(FEV1)、第1秒用力肺活量百分比(FEV1%)、第1秒用力肺活量与用力肺活量比(FEV1/FVC)、最大通气量(MVV)康复后较康复前(1.30±0.30Lvs.1.24±0.40L,59.19±18.00Lvs.51.89±14.00L,47.74±12.00Lvs.46.59±10.00L,56.63±13.00Lvs.49.67±13.00L)增加不显著(P>0.05);一氧化碳弥散能力(DLco)康复前和康复后(19.38±18.00Lvs.15.38±4.10L)变化不明显(P>0.05)。(2)6-分钟步行距离(6-MWD)在肺康复后显著高于康复前(594.87±116.00mvs.502.67±157.00m,P<0.05);呼吸困难指数(Borg指数)在康复后显著低于康复前(0.12±0.10vs.0.26±0.20,P<0.05);疲劳指数在康复后显著低于康复前(0.12±0.10vs.0.24±0.20,P<0.05)。(3)呼气峰流速(PEF)在康复后显著高于康复前(255.33±70.00L/min vs.209.33±66.00L/min,P<0.05)。(4)30例接受手术治疗患者,围手术期无死亡(术后30d内),术后出现肺部并发症(PPC)8例,术后平均住院时间为8.0±2.4d。结论术前肺康复可提高肺癌伴中-重度COPD患者的运动耐力,可能对肺癌伴中重度COPD患者降低术后肺部并发症有所帮助。

Objective To evaluate the impact of short-term preoperative pulmonary rehabilitation （PR） on the exercise capacity of lung cancer patients with moderate to severe chronic obstructive pulmonary disease（COPD）. Methods Between March 2009 and August 2010, 30 lung cancer patients with moderate or severe COPD were treated with preoperative comprehensive PR for two weeks in Department of Thoracic Surgery, West China Hospital. The sample was comprised of 18 males and 12 females with an average age of 62.5±7.7 years. Twelve of the patients had moderate COPD, while 18 had severe COPD. We collected information on the length of postoperative hospital stay for each patient, as well as any pulmonary complications. Results （1） The forced expiratory volume in one second （FEVI）, forced expiratory volume in one second （FEV%）, forced expiratory volume in/ forced vital capacity （FEV,/FVC）, and maximal ventilatorv volume （MVV） （1.30±0.30 L, 59.19±18.00 L, 47.74±12.00 L, 56.63±13.00 L） values after PR were slightly better than those before PR （1.24±0.40 L, 51.89±14.00 L, 46.59±10.00 L, 49.67±13. 00 In, but not significantly so（P〉0.05）. The results for carbon monoxide diffusion capacity were similar. （2） The six-minute walking distance （before： 502. 67±157. 00 m, after： 594. 87±116. 00 m）, peak expiratory flow （before： 209.33±66.00 I./min, after： 255.33±70.00 L/min）, dyspnea index （Borg index） （before： 0.26±0. 20, after： 0. 12±0. 10）, and fatigue index （before： 0. 24±0. 20, after： 0. 12±0. 10） all improved significantly after comprehensive PR （P〈0.05）. （3） All 30 patients underwent surgery, and none died during the perioperative period. Eight patients experienced cardiopulmonary complications. The average hospitalization time after surgery was 8.0±2.4 days. Conclusion Preoperative comprehensive PR appears to significantly improve exercise capacity and reduce the rate of postoperative lung complications in lung cancer, patients with lower cardiopulmonary function.