术前系统呼吸训练对单肺通气肺癌根治术患者术后短期呼吸运动功能及应激反应的影响

Effect of preoperative systematic breathing training on short-term respiratory movement and stress response in patients with single lung ventilation after radical resection of lung cancer

目的探讨术前系统呼吸训练对单肺通气肺癌根治术患者术后短期呼吸运动功能及应激反应的影响。方法选取2015年6月至2017年1月间中国医科大学肿瘤医院辽宁省肿瘤医院收治的134例肺癌患者,采用随机数表法将所有患者分为研究组和对照组,每组67例。所有患者均采用单肺通气肺癌根治术治疗,研究组患者在常规护理基础上给予术前系统呼吸训练,对照组患者给予常规护理。对两组患者入院时及出院时的气短自测量表Borg评分、第一秒用力呼气量(FEV1)、用力肺活量(FVC)、FEV1/FVC比值及6分钟步行试验(6 MWT)结果进行比较分析,同时观察比较两组患者干预前后的心率(HR)、收缩压(SBP)、舒张压(DBP)水平、汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评分。结果两组患者经过治疗出院时FEV1、FVC和FEV1/FVC水平均显著升高,研究组患者出院时的FEV1、FVC和FEV1/FVC水平均明显高于对照组患者,差异均有统计学意义(均P<0.05)。两组患者入院时Borg评分及6 MWT结果比较,差异无统计学意义(P>0.05),术后两组患者的Borg评分均显著升高,6 MWT结果显著降低,差异均有统计学意义(均P<0.05),研究组患者出院时Borg评分显著低于对照组患者,6 MWT结果显著高于对照组患者,差异均有统计学意义(均P<0.05)。两组患者干预前HAMD评分、HAMA评分、HR、SBP及DBP水平比较,差异均无统计学意义(均P>0.05),经过干预后,两组患者的HAMD评分、HAMA评分、HR、SBP及DBP水平均显著降低,其中研究组患者干预后的HAMD评分、HAMA评分、HR、SBP及DBP水平均低于对照组患者,差异均有统计学意义(均P<0.05)。结论术前系统呼吸训练能有效提升单肺通气肺癌根治术患者的短期呼吸运动功能,改善患者的应激状态,缓解患者焦虑和抑郁等不良情绪,促进患者预后恢复,值得临床推广。

Objective To investigate the effects of preoperative systemic breathing training on short-term respiratory function and stress response in patients with single lung ventilation after radical resection of lung cancer. Methods From June 2015 to January 2017,134 patients with lung cancer were treated at Liaoning Cancer Hospital of China Medical University. The patients were divided into a study group and a control group with 67 each by random number method. All patients were treated with single lung ventilation and radical resection of lung cancer. Patients in the study group were given preoperative respiratory training and patients in the control group received routine preoperative propaganda,surgical treatment and postoperative nursing care. Borg score,FEV1,FVC,and FEV1/FVC and 6 min walk test（ 6 MWT） were analyzed on admission and at discharge. Heart rate（ HR）,systolic pressure（ SBP）,diastolic blood pressure（ DBP）,Hamilton depression scale（ HAMD） and Hamilton anxiety scale（ HAMA） scores were observed and compared between the two groups before and after treatment. Results The levels of FEV1,FVC and FEV1/FVC significantly increased in the two groups at discharge. The FEV1,FVC and FEV1/FVC levels were significantly higher in the study group than in the control group at discharge（ P〈0. 05）. There was no significant difference between the two groups in the Borg score and 6 MWT results at admission（ P〈0. 05）.However,the Borg scores increased and 6 MWT decreased significantly in the two groups after the surgery（ all P〈0. 05）. The Borg score was significantly lower in the study group than in the control group and 6 MWT was significantly higher than those in the control group（ all P〈0. 05）. Before intervention,there were no significant difference in HAMD score,HAMA score,HR,SBP and DBP level between the two groups（ P〈0. 05） and after the intervention,HAMD score,HAMA score,HR,SBP and DBP levels significantly decreased in the two groups of patients with the study group significantly lower than the control group（ P〈0. 05）. Conclusion Preoperative systematic respiration training can effectively enhance shortterm respiratory motion function,improve stress response,relieve anxiety and depression and promote recovery in patients with lung cancer receiving the single lung ventilation,which is worthy of promotion.