引导呼吸训练在老年肺癌患者术后康复中的应用效果评价

The effects of a guided breathing training on postoperative rehabilitation of older patients with lung cancer

目的探讨引导呼吸训练在胸腔镜下肺叶切除术后老年肺癌患者康复中的应用效果。方法采用随机数字表法将北京某医院胸外科2020年6月—10月收治的78例胸腔镜下肺叶切除术后老年肺癌患者分为试验组(40例)和对照组(38例)。试验组患者接受常规肺康复治疗和引导呼吸训练,其中引导呼吸训练包括肋间肌松动术、肋骨松动术、胸廓诱导和腹式呼吸诱导;对照组患者接受常规肺康复治疗,比较两组手术前与手术术后第28天肺功能、手术并发症发生率、保留胸管时间及住院时间。结果术后第28天,试验组呼气峰流速为(305±62)L/min,对照组为(223±42)L/min,两组比较差异有统计学意义(t=6.773,P<0.001);试验组第1秒用力呼气容积为(1.8±0.4)L,对照组为(1.6±0.3)L,两组比较差异有统计学意义(t=2.799,P=0.006);试验组术后肺炎和肺不张合计发生率(20.0%)低于对照组(44.7%)(χ^(2)=11.744,P=0.001);试验组留置胸管时间为(80±31)h,对照组为(97±36)h,两组比较差异有统计学意义(t=2.193,P=0.031);试验组术后住院天数(4.2±1.5)d少于对照组(5.1±1.4)d(t=2.764,P=0.007)。结论引导呼吸训练可以改善胸腔镜下肺叶切除术后老年肺癌患者肺功能,降低肺炎和肺不张的发生率,缩短保留胸管时间和住院时间。

Objective To explore the effects of guided breathing training on the rehabilitation of older patients with lung cancer after thoracoscopic lobectomy.Methods A total of 78 older patients with lung cancer after thoracoscopic lobectomy were randomly assigned into the experimental group(40 cases)and the control group(38 cases).Patients in the experimental group received guided breathing training,including intercostal muscle mobilization,rib mobilization,thoracic induction and abdominal breathing induction.Patients in the control group received routine pulmonary rehabilitation treatment.The pulmonary function before and 28 days after the operation,surgical complications,chest tube retention time and hospital stay were compared between the two groups.Results On the 28th day after operation,the peak expiratory velocity of the patients in the experimental group was(305±62)L/min while it was(223±42)L/min of patients in the control group(t=6.773,P<0.001).The forced expiratory volume in one second in the experimental group was(1.8±0.4)L and it was(1.6±0.3)L of patients in the control group(t=2.799,P=0.006).The combined incidence of postoperative pneumonia and atelectasis was lower in the experimental group(20.0%)than in the control group(44.7%)(χ^(2)=11.744,P=0.001).The length of indwelling chest tube in the experimental group was(80±31)h,and it was(97±36)h for patients in the control group(t=2.193,P=0.031).The days of postoperative hospitalization in the experimental group were(4.2±1.5)d which were less than that of patients(5.1±1.4)d in the control group(t=2.764,P=0.007).Conclusion Guided breathing training can improve lung function,reduce the incidence of atelectasis of pneumonia,shorten the time of retaining chest tube and hospital stay for elderly patients with lung cancer after thoracoscopic lobectomy.