主动呼吸训练对食管癌术后患者肺功能及生活质量的影响

The effect of active respiratory exercise on pulmonary function and quality of life after an operation for carcinoma of the esophagus

目的 观察渐进式主动呼吸训练对中老年食管癌术后患者肺功能及生活质量的影响.方法 共选取中老年食管癌术后患者40例,采用随机数字表法将其分为呼吸训练组及对照组.对照组患者给予胸外科常规康复护理,呼吸训练组在此基础上辅以三阶段胸式或腹式、屏气呼吸训练及呼吸体操训练.于治疗3,6,12个月后分别采用肺功能检测、6 min步行试验及36条目简明健康调查量表（SF-36）对2组患者肺功能、运动能力和生活质量进行评定.结果 经12个月治疗后,发现呼吸训练组患者肺功能指标[其用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、最大通气量（MVV）、50％用力呼气流量（FEFS0）和肺一氧化碳弥散量（DLCO）分别提高23％、26％、15％、30％和12％]、6 min步行距离[由（320.30±13.00）m提高至（449.30± 12.80） m]及生活质量SF-36量表8个领域评分均较治疗前及对照组明显改善（P＜0.05）;对照组患者各项肺功能指标及6 min步行距离亦较治疗前有一定程度改善,但差异无统计学意义（P＞0.05）;其SF-36量表中躯体功能、心理健康、身体疼痛、角色心理、综合健康评分较治疗前明显改善（P＜0.05）,但角色受限、社会功能及活力/精力3个领域评分与治疗前差异仍无统计学意义（P＞0.05）.结论 食管癌术后患者早期给予渐进式主动呼吸训练,能有效抑制因胸部肌肉、肋间肌和膈肌损伤所致的肺功能下降,有效提高术后患者肺活量、运动能力及日常生活活动能力,对改善患者术后生活质量具有重要意义.

Objective To explore the effect of progressive active respiratory exercise on the pulmonary function and quality of life of middle-aged and elderly patients after surgery for carcinoma of the esophagus.Methods Forty post-operative middle-aged and elderly patients with carcinoma of esophagus were randomized into 2 groups.The patients in the control group were given conventional thoracic nursing,while those in the experimental group were given 3-step thoracic or abdominal breathing training,breath holding training and respiratory gymnastics training in addition.A lung function test,the 6-min walk test and a 36-item short form health survey （SF-36）were used to evaluate the subjects＇ pulmonary function,motor ability and quality of life after 3,6 and 12 months of treatment.Results Vital capacity （VC） increased 23％ after training.Forced vital capacity （FVC） increased 16％.Maximal ventilation volume （MVV） increased 15％ and 50％ of forced expiratory flow （FEFS0） and the diffusing capacity for carbon monoxide of the lungs （DLCO） increased 30％.Average distance in the 6-minute walk test （6MWD） lengthened from 320 m to 449 m,and the quality of life of the patients in the experimental group improved much more than that of the control group.The average pulmonary function and 6MWD of the control group did not improve significantly with only nursing care.Their average SF-36 scores for physical function,mental health,physical pain,mental role and comprehensive health did,however,improve significantly after treatment.The changes in their role limitation,social function and energy scores were not significant.Conclusion Early and progressive active respiratory exercise can ameliorate lung dysfunction after a thoracic operation,and improve motor ability and quality of life.