围术期全程深呼吸功能训练对老年食管癌患者术后快速康复的影响

Effect of Deep Breathing Training on Postoperative Rapid Recovery of Elderly Patients with Esophageal Cancer

目的:探讨围术期自主深呼吸功能训练联合雾化吸入治疗对高龄食管癌患者术后肺功能快速康复的影响。方法:120例食管癌术后患者,年龄均在60岁以上,根据入院先后顺序随机分为4组:A组:布地奈德雾化吸入治疗;B组:在雾化治疗基础上,仅术前加用自主深呼吸功能训练器锻炼肺功能;C组:在雾化基础上,仅术后进行深呼吸功能训练肺功能;D组:雾化基础上,术前以及术后均使用自主深呼吸功能训练治疗。动态观察比较术后第1天、第3天、第5天、第7天各组患者血清PCT值,肺复张情况、呼吸道分泌物排泄情况、胸部引流管留置时间、术后抗生素使用时间、术后住院时间。结果:A、B、C、D四组术后各检测时间点PCT水平之间差异无统计学意义(P>0.05);气道分泌物排泄、术后肺复张情况以及术后胸部引流管留置时间,D组、C组效果均优于A组、B组,其中,D组效果最佳,差异有统计学意义(P<0.05),A组与B组之间未见统计学差异(P>0.05);术后住院时间、术后抗生素使用时间,D组、C组小于A组、B组,差异均有统计学意义(P<0.05),D组与C组,B组与A组之间差异无统计学意义(P>0.05)。结论:早期自主深呼吸功能锻炼能够促进老年食管癌患者术后肺功能快速康复;单纯术前自主深呼吸功能锻炼对术后肺功能快速康复影响较小,但能够显著增加术后自主深呼吸功能锻炼的效果,缩短术后胸部引流管留置时间及术后住院时间,使老年食管癌患者术后快速康复获益。

Objective To investigate the effect of perioperative spontaneous deep breathing function training combined with nebulized inhalation therapy on the rapid recovery of postoperative pulmonary function in elderly patients with esophageal cancer. Methods 120 cases of postoperative esophageal cancer patients, aged over 60 years old, were randomly divided into 4 groups according to the order of admission:Group A: Budesonide atomization inhalation treatment;Group B: on the basis of atomization treatment, the preoperative use of the independent deep breathing training device to exercise lung function;Group C: on the basis of atomization, the postoperative deep breathing training lung function;Group D: on the basis of atomization, the patients were treated with self deep breathing training before and after operation. The serum PCT value, the pulmonary reexpansion, excretion of respiratory secretions, retention time of thoracic catheter, usage time of antibiotics and hospitalization time were observed and compared dynamically on the 1 st, 3 rd, 5 th and 7 th day after operation. Results There was no significant difference in the level of PCT between groups A, B, C and D at each time point after operation(P>0.05). The overviews of airway secretion excretion, postoperative lung recruitment and retention time of thoracic catheter were better in groups C and D than those in groups A and B. Among them, group D had the best effect, and the difference was statistically significant( P<0.05). There was no statistical difference between group A and group B(P>0.05). The postoperative hospital stay and postoperative antibiotic use time were significantly shorter in groups D and C than those in groups A and B(P<0.05). There was no significant difference between group D and group C or between group A and group B(P> 0.05). Conclusion Early autonomic deep breathing exercise can promote the rapid recovery of postoperative pulmonary function in elderly patients with esophageal cancer. The preoperative autonomic deep breathing exercise has little effect on the rapid recovery of postoperative pulmonary function, but it can significantly increase the effect of postoperative self-directed deep breathing exercise, shorten the postoperative retention time of chest catheter and postoperative hospital stay, so that elderly patients with esophageal cancer benefit from rapid recovery after surgery.