强化肺康复锻炼在重度肺通气功能障碍肺癌患者围手术期中的应用效果分析

Analysis on application effect of strengthened pulmonary rehabilitation exercise in lung cancer patients with severe pulmonary ventilation dysfunction in perioperative period

目的：探讨强化肺康复功能锻炼在重度肺通气功能障碍肺癌患者围手术期中的应用效果。方法收集2013年3月至2015年4月接受胸腔镜下肺癌根治术的96例患者，且术前肺功能检查提示为重度肺通气功能障碍，将患者按随机数字表法分为常规组和干预组各48例，其中常规组患者采取常规围手术期护理措施，干预组患者在此基础上采取强化肺康复干预方案，比较2组患者术前肺功能变化、术后机械通气时间、术后氧疗时间、胸管留置时间、术后住院时间及术后并发症发生情况。结果经过强化肺康复干预，干预组患者除第1秒用力呼气容积无明显变化外，术前1 d 时用力肺活量、最大通气量、一氧化碳弥散总量、千克摄氧量及氧脉搏分别为（2.63±0.47） L、（53.14±9.40） L、（19.26±2.63） ml·min-1·mmHg-1（1 mmHg=0.133 kPa）、（23.15±4.36） ml/kg 及（10.98±2.52） ml·min-1·次-1，明显高于干预前的（2.41±0.40） L、（46.98±8.91） L、（17.56±2.83） ml·min-1·mmHg-1、（20.17±4.35） ml/kg及（9.82±2.07） ml·min-1·次-1，差异有统计学意义，t=2.521、3.512、3.112、3.421、2.515，P＜0.01或0.05；常规组上述指标无明显变化。干预组患者机械通气时间、术后氧疗时间、胸管留置时间及术后住院时间分别为（9.42±3.17） h、（76.23±21.18） h、（3.58±1.44） d 及（6.62±2.14） d，明显短于常规组的（17.29±4.79） h，（92.14±24.29） h、（4.73±2.15） d 及（8.68±2.96） d，差异有统计学意义，t=9.688、3.491、3.143、3.988，P＜0.01；干预组术后肺部感染、肺不张及呼吸衰竭发生率分别为12.50%（6/48）、10.42%（5/48）及4.17%（2/48），均明显低于常规组的41.67%（20/48）、29.17%（14/48）及18.75%（9/48），差异有统计学意义，χ2=10.338、5.315、5.031，P＜0.01或0.05。结论强化肺康复干预措施可改善肺癌合并重度肺通气功能障碍患者术前肺功能状态，降低术后并发症的发生率，提升围手术期的安全性，值得在临床进一步推广。

Objective To explore the application effect of strengthened pulmonary rehabilitation exercise in lung cancer patients with severe pulmonary ventilation dysfunction during perioperative period. Methods A total of 96 patients receiving lung cancer radical treatment under thoracoscope in our hospital during March 2013 to April 2015 were collected, and for all these patients, pulmonary function test before treatment showed that there was severe pulmonary ventilation dysfunction. The patients were divided into the routine group and the intervention group by random digital table method, with 48 patients in each group;patients in the routine group received routine perioperative nursing, and those in the intervention group received the strengthened pulmonary rehabilitation intervention plan; change in pulmonary function before treatment, duration of mechanical ventilation, time of oxygen therapy, retaining time of chest tube, length of hospital stay and occurrence of complications after treatment were compared between the two groups. Results After strengthened pulmonary rehabilitation intervention in the intervention group, the FVC was (2.63±0.47) L, the MVV was(53.14±9.40) L, the DLCO was(19.26±2.63) ml·min-1·mmHg-1, the VO2 was&nbsp;(23.15±4.36) ml/kg and the O2Pulse was(10.98±2.52) ml·min-1·times-1, Which were significantly improved compared with those before treatment, (2.41±0.40) L,(46.98±8.91) L,(17.56±2.83) ml·min -1·mmHg -1, (20.17±4.35)ml/kg and(9.82±2.07) ml·min-1·times-1, t=2.521, 3.512, 3.112, 3.421, 2.515, P<0.01 or 0.05. While there was no obvious change in the above- mentioned indexes of those in the routine group. After treatment of patients in the intervention group the duration of mechanical ventilation was (9.42±3.17) hours, time of oxygen therapy was (76.23±21.18) hours, retaining time of chest tube was (3.58±1.44) days and length of hospital stay was (6.62±2.14) days, which were significantly shorter than those in the routine group, (17.29±4.79) hours,(92.14±24.29) hours, (4.73±2.15) days and(8.68±2.96) days. The occurrence rates of complications such as pulmonary infection, pulmonary atelectasis and respiratory failure were 12.50%(6/48),10.42%(5/48) and 4.17%(2/48)in the intervention group, significantly lower than those in the routine group, 41.67%(20/48),29.17%(14/48) and 18.75%(9/48), χ2=10.338, 5.315, 5.031, P <0.01 or 0.05. Conclusions Strengthened pulmonary rehabilitation intervention can improve pulmonary function of lung cancer patients with severe pulmonary ventilation dysfunction before treatment, reduce the occurrence rate of post- operative complications and enhance safety during the perioperative period; it is worth of being further promoted clinically.