不同切口手术联合加速康复外科理念指导下的呼吸功能训练在肺癌患者中的应用效果

Application effect of different incision surgeries combined with respiratory function exercise under the guidance of enhanced recovery after surgery concept in patients with lung cancer

目的探讨不同切口手术联合加速康复外科(enhanced recovery after surgery,ERAS)理念指导下的呼吸功能训练在肺癌患者中的应用效果。方法选择2020年1月至2022年12月在苏州大学附属太仓医院择期行肺癌根治术的患者200例,随机分为4组,每组50例。A组接受单孔胸腔镜手术,术前ERAS宣教,呼吸训练器和常规呼吸功能训练;B组接受腋下肌肉非损伤性小切口手术,术前ERAS宣教,呼吸训练器和常规呼吸功能训练;C组接受腋下肌肉非损伤性小切口手术,术前常规宣教和常规呼吸功能训练;D组接受单孔胸腔镜手术,术前常规宣教和常规呼吸功能训练。比较4组患者术后恢复情况及术后疼痛评分。结果与其他3组相比,A组患者肺部并发症发生率降低,下床时间更早,置管时间、住院时间均缩短(P<0.05);与B组、C组相比,A组患者术后疼痛显著减轻(P<0.05)。与C组相比,B组患者肺部并发症发生率降低,下床时间、置管时间、住院时间缩短(P<0.05)。手术切口相同组间的术后疼痛差异无统计学意义。结论单孔胸腔镜肺癌手术联合ERAS理念指导下的呼吸功能训练可明显降低患者术后肺部并发症发生率,减轻术后疼痛,加速康复。

Objective To explore the efficacy of different incision surgeries combined with respiratory function exercise under the guidance of enhanced recovery after surgery(ERAS)in lung cancer patients.Methods From January 2020 to December 2022,a total of 200 patients in Taicang Affiliated Hospital of Soochow University were collected and randomly divided into 4 groups,with 50 patients in each group.Patients in group A received single-hole thoracoscopic surgery,preoperative ERAS concept education and respiratory trainer combined with routine respiratory function exercise;patients in group B received subaxillary noninvasive small incision surgery,preoperative ERAS concept education and respiratory trainer combined with routine respiratory function exercise;patients in group C received subaxillary non-invasive small incision surgery,preoperative routine hospitalization education and respiratory function exercise;patients in group D received single-hole thoracoscopic surgery,preoperative routine hospitalization education and respiratory function exercise.The postoperative recovery indicators and postoperative pain score were compared among the four groups.Results Compared with the other three groups,patients in group A had reduced incidence of pulmonary complications,earlier mobilization,earlier removal of the chest tube and shorter length of hospital stay(P<0.05);compared with group B and group C,patients in group A had reduced postoperative pain score(P<0.05).Compared with group C,patients in group B had reduced incidence of pulmonary complications,earlier mobilization,earlier removal of the chest tube and shorter length of hospital stay(P<0.05).There was no significant difference in postoperative pain score between patients in group A and group D,and patients in group B and group C.Conclusions For lung cancer patients,single-hole thoracoscopic surgery combined with respiratory function exercise under the guidance of ERAS concept can effectively reduce the incidence of pulmonary complications and postoperative pain,and promote postoperative recovery.