主动循环呼吸训练联合肺保护性通气策略对胸腔镜下肺癌根治术后患者肺功能、炎症因子及氧化应激指标的影响

Effects of Active Cycle of Breathing Techniques Combined with Lung Protective Ventilation Strategy on Lung Functions,Inflammatory Factors and Oxidative Stress Indexes in Patients after Thoracoscopic Radical Resection of Lung Cancer

目的:探讨主动循环呼吸训练(active cycle and breathing training,ACBT)联合肺保护性通气策略(lung protective ventilation strategy,LPVS)对胸腔镜下肺癌根治术后患者的肺功能、炎症因子和氧化应激指标的影响。方法:选取我院2018年6月至2020年12月期间收治的120例经胸腔镜下肺癌根治术后患者作为研究对象,采用随机数字表法将研究对象分为观察组(n=60)和对照组(n=60),对照组给予LPVS,观察组在LPVS基础上行ACBT,对比两组患者肺功能[最大肺活量(VCmax)、用力肺活量(FVC)、第1s用力呼气容积(FEV1)、峰值呼气流速(PEF)]、炎症因子[肿瘤坏死因子-a(TNF-a)、白介素-8(IL-8)、白介素-1O(IL-1O)]和氧化应激指标[超氧化物歧化酶(S0D)、丙二醛(MDA)]之间的差异。结果:干预前两组患者的VCmax、FVC、FEVl和PEF值之间差异均无统计学意义(均P>0.05);而干预后均表现为观察组患者的VCmax、FVC、FEVl和PEF值高于对照组,差异均有统计学意义(均P<0.001);两组患者均表现为干预后的VCmaX、FVC、FEVl和PEF值升高(均P<0.001),但观察组的上述肺功能指标的升高幅度更明显。干预前两组患者的TNF-a、IL-8和1L-10之间差异均无统计学意义(均P>0.05);而干预后观察组患者的TNF-a、IL-8和IL-10均低于对照组,差异均有统计学意义(均P<0.001)。两组患者均表现为干预后的TNF-a、L-8和IL-10降低(均P<0.001),但观察组的上述炎症因子指标的下降幅度更明显。干预前两组患者的MDA、SOD之间差异均无统计学意义(均P>0.05);而干预后观察组患者的MDA低于对照组,SOD高于对照组,差异均有统计学意义(均P<0.001)。两组患者均表现为干预后的MDA降低,SOD升高(均P<0.001),但观察组的变化幅度更明显。结论:ACBT联合LPVS可以改善胸腔镜下肺癌根治术后患者的肺功能、降低机体炎症反应及氧化应激反应。

Objective:To explore the effects of active cycle of breathing techniques(ACBT)combined with lung protective ventilation strategy(LPVS)on lung functions,inflammatory factors and oxidative stress in lung cancer patients after thoracoscopic radical resection.Methods:A total of 120 patients undergoing thoracoscopic radical resection of lung cancer in our department from June 2018 to December 2020 were selected as the research objects.The research objects were randomly assigned to the observation group(n=60)and the control group(n=60).The control group was given LPVS,and the observation group was given LPVS combined with ACBT.Lung functions[maximum vital capacity(VCmax),forced vital capacity(FVC),forced expiratory volume in the first second(FEV1)and peak expiratory flow(PEF)],inflammatory factors[tumor necrosis factor-a(TNF-a),interleukin-8(IL-8)and interleukin-10(IL-10)]and oxidative stress indexes[super-oxide dismutase(SOD)and malondialdehyde(MDA)]in the two groups were compared.Results:Before intervention,there were no significant differences in VCmax,FVC,FEV1 and PEF between two groups(all P>0.05);after intervention,VCmax,FVC,FEV1 and PEF in the observation group were significantly higher than those in the control group(all P<0.001);the above values in both groups increased after intervention(all P<0.001),but the increase in the observation group was more significant.Before intervention,there were no significant differences in TNF-a,IL-8 and IL-10 between two groups(all P>0.05);after intervention,TNF-a,IL-8 and IL-10 in the observation group were significantly lower than those in the control group(all P<0.001);the above values in both groups decreased after intervention(all R<0.001),but the decrease of in the observation group was more significant.Before intervention,there were no significant differences in MDA and SOD between two groups(all P>0.05);after intervention,MDA in the observation group was lower than that in the control group,while SOD in the former was higher than that in the latter(all P<0.001);hoth groups showed decreased MDA and increased SOD after intervention(all P<0.001),but changes in the observation group was more significant.Conclusion:ACBT combined with LPVS can improve lung functions,reduce inflammatory reactions and oxidative stress reactions in patients with lung cancer after thoracoscopic radical resection.