术前短期高强度肺康复训练对肺癌合并COPD患者围手术期并发症的影响

Effect of A High Intensive Preoperative Rehabilitation on the Perioperative Complications in Patients with Chronic Obstructive Pulmonary Disease Eligible for Lung Cancer Surgery

背景与目的慢性阻塞性肺病(chronic obstructive pulmonary diseases, COPD)降低患者心肺功能,可导致患者围手术期风险增加。本研究拟探讨术前短期高强度肺康复训练对肺癌合并COPD患者肺功能及术后并发症的影响。方法分析2016年6月-2016年12月101例肺癌合并COPD患者的临床资料,其中肺康复训练组43例,常规治疗组58例,比较两组患者肺功能、术后肺部并发症、住院时间等指标,同时比较肺康复训练组训练前后肺功能相关指标。结果两组患者术前一般资料及肺功能无显著差异,康复训练组住院时间更长[(17.23±4.18) d vs (14.41±4.03) d],但术后住院时间与常规治疗组无显著差异[(8.93±3.78) d vs (9.62±3.98) d],两组患者术后肺部感染[8例(18.6%) vs 17例(29.3%)]、肺不张[1例(2.3%) vs 1例(1.7%)]、呼吸衰竭[1例(2.3%) vs 2例(3.4%)]等无显著差异。肺康复训练组训练前后FEV_1[(2.06±0.45) L vs (2.15±0.45) L, P<0.001]、PEF[(4.32±0.90) L/s vs (5.15±1.05) L/s, P<0.001]、PCO_2[(42.42±2.79) mmHg vs (41.58±2.98) mmHg, P=0.009]改善明显,按亚组分析,康复训练后中-重度COPD亚组FEV_1[(0.16±0.05) L (8.6%) vs (0.06±0.05) L (2.8%)]增加值较轻度COPD亚组更明显。结论术前短期肺康复训练可改善肺癌合并COPD患者肺功能,其中中-重度COPD患者肺功能改善更明显。

Background and objective Chronic obstructive pulmonary disease (COPD)will reduce the cardio- pulmonary function and increase perioperative risk.The aim of this study is to investigate the effect of preoperative short- term high intensity lung rehabilitation training on lung function and postoperative complications in patients with COPD who are eligible for lung cancer surgery:Methods We analysis of 101patients with COPD and a diagnosis of lung cancer,with 43 patients in pulmonary rehabilitation group and 58patients in conven,fional group.The pulmonary function,postoperative pul- monary complications (PPCs)and length of stay (LOS)will be compared between the two groups,the lung function will be compared before and after the rehabilitation at the same time.Results There were no significant difference between the two groups in general information,lung function before surgery,postophrative pulmonary infection [8(18.6%)vs 17(29.3%)], atelectasis [1(2.3%)vs 1(1.7%)],respiratory failure [1(2.3%)vs 2(3.4%)]and postoperative LOS [(8.93±3.78)d vs (9.62± 3.98)d,P>0.05].In the rehabilitation group,the FEV1[(2.06±.0.45)L vs (2.15±0.45)L,P<0.001]and PEF [(4.32±0.90)L/s vs (5.15±1.05)L/s,P<0.001)were higher,and PCO2[(42.42±2.79)mmHg vs (41.58±2.98)mmHg, P=0.009]was lower after rehabilitation,significantly.The increase value of FEV1 in moderate to severe.COPD group was higher than that of the mild COPD group after the rehabilitation [(0.16±0.05)L,8.6%vs (0.06±0.05)L,2.8%,P<0.001).Conclusion The short-term highly-intensity lung rehabilitation can improve lung function in lung cancer patients with COPD,and the improvement of pulmonary function in moderate to severe COPD patients is more obviously.