术前肺康复训练对肺癌患者术后肺炎的影响

Effect of preoperative pulmonary rehabilitation on postoperative pneumonia in patients with lung cancer

目的探讨术前肺康复训练是否有助于预防术后肺炎的发生。方法回顾性分析华西医院胸外科2014年1月—2015年6月792例行手术治疗的肺癌患者的临床资料,其中肺康复训练组患者148例,常规治疗组644例患者,比较两组患者术后肺炎的发生率以及相关临床指标。同时,采用单因素和多因素分析术后肺炎的危险因素。结果肺康复训练组术后肺炎发生率显著低于常规治疗组,差异有统计学意义(8.1%vs 15.8%,P=0.013);肺康复训练组抗生素使用时间、胸腔引流管留置时间、术后住院日及住院药费均显著低于常规治疗组,差异也均有统计学意义[(4.1±2.1)d vs(4.9±2.5)d,P<0.001;(3.8±2.3)d vs(4.3±2.8)d,P=0.023;(5.9±3.2)d vs(7.2±4.6)d,P<0.001;(7 354.3±2 743.2)元vs(8 265.2±3 126.5)元,P=0.001]。单因素和Logistic多元回归分析显示:术后肺炎发生的危险因素包括年龄>70岁(OR=6.998,95%CI:4.236~11.561,P<0.001)、吸烟史(OR=2.286,95%CI:1.145~4.456,P=0.019)、开胸手术(OR=1.990,95%CI:1.247~4.3.177,P=0.004)、手术时间>180min(OR=7.228,95%CI:2.657~19.666,P<0.001);术前肺康复训练有助于降低术后肺炎的发生(OR=0.377,95%CI:0.188~0.756,P=0.006)。结论术前肺康复锻炼能够降低肺癌患者术后肺炎的发生率,且有助于术后快速康复。

Objective The purpose of this study was to investigate whether preoperative pulmonary rehabilitation could prevent postoperative pneumonia.Methods Retrospective research was conducted on 792 lung cancer patients who underwent lobectomy at the West China Hospital of Sichuan University from January 2014 to July 2015.The patients were divided into two group including 148 patients with pulmonary rehabilitation and 644 patients without pulmonary rehabilitation;the incidence of postoperative pneumonia and the related clinical data were compared between the two groups.Results The incidence of postoperative pneumonia in the pulmonary rehabilitation group was significantly lower than that in the non-pulmonary rehabilitation group(8.1% vs 15.8%,P=0.013);The antibiotic use time,chest tube duration,postoperative hospital stay and drug costs in pulmonary rehabilitation group were statistically lower than non-pulmonary rehabilitation group [(4.1±2.1)d vs(4.9±2.5)d,P<0.001;(3.8±2.3)d vs(4.3±2.8)d,P=0.023;(5.9±3.2)d vs(7.2±4.6)d,P<0.001;(7 354.3±2 743.2)$ vs(8 265.2±3 126.5)$,P=0.001].The risk factors of postoperative pneumonia include age>70years(OR=6.998,95% CI:4.236-11.561,P<0.001),smoking history(OR=2.286,95% CI:1.145-4.456,P=0.019),thoracotomy(OR=1.990,95% CI:1.247-4.3.177,P=0.004)and duration of surgery>180 min(OR=7.228,95% CI:2.657-19.666,P<0.001).Conclusions Preoperative pulmonary rehabilitation can reduce the incidence of postoperative pneumonia(OR=0.377,95% CI:0.188-0.756,P=0.006)and enhance recovery after surgery in patients with lung cancer.