肺切除术患者围手术期行走功能受损调查及其影响因素分析

Analysis of perioperative walking impairment and its infl uencing factors in patients undergoing lung resection

目的 调查肺切除术患者围手术期行走功能受损情况及其影响因素。方法 回顾性分析2017年11月至2020年1月在四川省6家三级医院进行的一个肺癌围手术期症状调查队列(CN-PRO-Lung 1)中的497例患者(四川省肿瘤医院435例,成都市第三人民医院20例,江油市人民医院14例,自贡市第一人民医院13例,成都市第七人民医院8例,大竹县人民医院7例)的临床资料。采用MD安德森症状量表-肺癌子表(MD Anderson Symptom Inventory-Lung Cancer,MDASI-LC)评估患者围手术期行走功能受损的严重程度:2~4分定义为中度行走功能受损,≥5分定义为重度行走功能受损。出院时行走功能有效填写例数为402例。对其采用logistic回归分析确定患者出院时行走功能受损的危险因素。结果 患者术前、术后第1天、出院当天、出院1周和出院4周中重度行走功能受损发生率分别为8.9%、77.6%、53.5%、66.9%和54.8%,重度行走功能受损发生率分别为3.4%、60.0%、20.6%、27.6%和17.3%。多因素logistic回归分析显示,中重度(≥4分)疲劳、疼痛和气短均是患者出院时中重度行走功能受损的独立危险因素(均P<0.05);中重度疲劳、疼痛、气短和咳嗽均是患者出院时重度行走功能受损的独立危险因素(均P<0.05)。结论 积极控制术后症状,可改善接受肺切除术的患者出院时的行走功能,让其尽快回归正常生活和工作。

Objective To investigate the perioperative walking impairment and its influencing factors in patients undergoing lung resec-tion.Methods The clinical data of 497 patients in a cohort study investigating perioperative symptoms of lung cancer patients(CN-PRO-Lung 1)from November 2017 to January 2020 in 6 tertiary hospitals in Sichuan province were retrospectively analyzed,including 435 cases from Sichuan Cancer Hospital,20 from Chengdu Third People's Hospital,14 from Jiangyou People's Hospital,13 from Zigong First People's Hospital,8 from Chengdu Seventh People's Hospital and 7 from Dazhu County People's Hospital.The severity of patients'perioperative walking impairment was assessed using the MD Anderson Symptom Inventory-Lung Cancer(MDASI-LC).A score of 2-4 was defined as moderate walking impairment,and a score of≥5 was defined as severe walking impairment.At discharge,the scores of walking ability were validly rated in 402 patients.Logistic regression was used to determine the risk factors for walking impairment at discharge.Results The incidences of moderate-to-severe walking impairment before surgery,on postoperative day 1,on the day of discharge,one week after dis-charge and four weeks after discharge were 8.9%,77.6%,53.5%,66.9%and 54.8%,respectively;the incidences of severe walking impairment were 3.4%, 60.0%, 20.6%, 27.6% and 17.3%, respectively. Multivariate logistic regression analysis showed that moderate-to-severe (score≥4) fatigue, pain, and shortness of breath were independent risk factors for moderate-to-severe walking impairment at discharge (all P<0.05);moderate-to-severe fatigue, pain, shortness of breath, and coughing were independent risk factors for severe walking impairment at discharge (all P<0.05). Conclusions Active control of postoperative symptoms can improve the walking ability of patients undergoing lung resection at discharge and allow them to return to normal life and work as soon as possible.