呼吸训练对肺癌手术患者术后肺功能的影响
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摘要
目的探讨呼吸训练对肺癌手术患者术后肺功能的影响。方法采用随机数字表法将96例行择期手术的肺癌患者随机分为对照组和观察组,各48例。对照组患者接受常规护理措施,观察组患者在此基础上接受呼吸训练,比较入院时和术后7天两组患者血气指标[动脉血氧分压(PaO_2)和动脉血二氧化碳分压(PaCO_2)]和肺功能指标[用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、呼气流量峰值(PEF)、每分钟最大通气量(MVV)、呼吸频率和潮气量]变化情况;出院时,比较两组患者术后恢复相关指标(拔管时间、呼吸机使用时间、下床活动时间、入住重症监护室时间和住院时间)及并发症发生率。结果术后7天,两组患者PaO_2、FVC、FEV1、PEF、MVV水平和潮气量均低于本组入院时(P﹤0.05),PaCO_2水平和呼吸频率均高于本组入院时(P﹤0.05);且观察组患者PaO_2、FVC、FEV1、PEF、MVV水平和潮气量均高于对照组患者(P﹤0.05),PaCO_2水平和呼吸频率均低于对照组患者(P﹤0.05)。观察组患者拔管时间、呼吸机使用时间、下床活动时间、入住重症监护室时间和住院时间均明显短于对照组患者(P﹤0.01),每日排痰量明显多于对照组患者(P﹤0.01)。观察组患者术后并发症总发生率为12.50%,明显低于对照组患者的39.58%,差异有统计学意义(P﹤0.01)。结论呼吸训练可有效改善肺癌手术患者的肺功能,改善血气指标并缩短术后恢复时间,降低术后并发症发生率。
Objective To investigate the effect of respiratory training on the pulmonary function of patients with lung cancer after surgery. Method The clinical data from 96 cases of lung cancer who were administered with elective surgery were included in the study, these patients were randomized as control group and study group, with 48 cases in each,respectively. The control group received conventional nursing care, while the study group was administered with respiratory training in addition to routine care, the changes of blood gas [arterial partial pressure of oxygen(PaO_2), arterial partial pressure of carbon dioxide(PaCO_2)] and pulmonary function [forced vital capacity(FVC), forced expiratory volume in one second(FEV1), peak expiratory flow(PEF), maximal voluntary ventilation(MVV), respiratory rate and tidal volume] at admission and in 7 days after surgery were compared between the two groups. Before discharge, the postoperative recovery(time to extubation, time of ventilator support, ambulation time, time in intensive care unit, and length of hospital stay) and the incidence of postoperative complications were evaluated and compared. Result Seven days after operation, the PaO_2, FVC, FEV1, PEF, MVV and tidal volume in both groups were decreased compared to those before admission(P<0.05), while PaCO_2 and respiratory rate were higher than those before admission(P<0.05); besides, PaO_2,FVC, FEV1, PEF, MVV and tidal volume were significantly higher in study group than in control group(P<0.05), while PaCO_2 and respiratory rate were lower instead(P<0.05). The time to extubation, time of ventilator support, ambulation time, time in intensive care unit, and length of hospital stay were shorter in study group(P<0.01), and sputum production were significantly increased compared with control group(P<0.01). The overall incidence of complications in study group was 12.50%, which was statistically lower than the 39.58% in control group, and the difference was of statistical significance(P<0.01). Conclusion Respiratory training can effectively ameliorate the pulmonary function in patients with lung cancer after surgery, improving postoperative respiratory conditions, shortening time needed for postoperative recovery, and may reduce the risk of postoperative complications.
Objective To investigate the effect of respiratory training on the pulmonary function of patients with lung cancer after surgery. Method The clinical data from 96 cases of lung cancer who were administered with elective surgery were included in the study, these patients were randomized as control group and study group, with 48 cases in each,respectively. The control group received conventional nursing care, while the study group was administered with respiratory training in addition to routine care, the changes of blood gas [arterial partial pressure of oxygen(PaO_2), arterial partial pressure of carbon dioxide(PaCO_2)] and pulmonary function [forced vital capacity(FVC), forced expiratory volume in one second(FEV1), peak expiratory flow(PEF), maximal voluntary ventilation(MVV), respiratory rate and tidal volume] at admission and in 7 days after surgery were compared between the two groups. Before discharge, the postoperative recovery(time to extubation, time of ventilator support, ambulation time, time in intensive care unit, and length of hospital stay) and the incidence of postoperative complications were evaluated and compared. Result Seven days after operation, the PaO_2, FVC, FEV1, PEF, MVV and tidal volume in both groups were decreased compared to those before admission(P<0.05), while PaCO_2 and respiratory rate were higher than those before admission(P<0.05); besides, PaO_2,FVC, FEV1, PEF, MVV and tidal volume were significantly higher in study group than in control group(P<0.05), while PaCO_2 and respiratory rate were lower instead(P<0.05). The time to extubation, time of ventilator support, ambulation time, time in intensive care unit, and length of hospital stay were shorter in study group(P<0.01), and sputum production were significantly increased compared with control group(P<0.01). The overall incidence of complications in study group was 12.50%, which was statistically lower than the 39.58% in control group, and the difference was of statistical significance(P<0.01). Conclusion Respiratory training can effectively ameliorate the pulmonary function in patients with lung cancer after surgery, improving postoperative respiratory conditions, shortening time needed for postoperative recovery, and may reduce the risk of postoperative complications.
引文
[1]姚源山,华青旺,沈海波.Ⅰ期非小细胞肺癌术后的预后分析[J].中国肿瘤外科杂志,2019,11(1):36-40.
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[11]Fernandez FG,Falcoz PE,Kozower BD,et al.The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases:joint standardization of variable definitions and terminology[J].Ann Thorac Surg,2015,99(1):368-376.
[12]赖玉田,苏建华,杨梅,等.术前短期综合肺康复训练对肺癌合并轻中度慢性阻塞性肺病患者的影响:一项前瞻性随机对照试验[J].中国肺癌杂志,2016,19(11):746-753.
[13]Lai Y,Du H,Wang X,et al.Status and perspectives of clinical modes in surgical patients with lung cancer:a retrospective study[J].Medicine(Baltimore),2016,95(2):e2429.
[14]孙玉宏,于绍芬.呼吸功能训练护理改善老年肺癌患者术后疗效指标[J].中国老年保健医学,2015,13(3):111-112.
[15]郭志斌,赵洪林,李梅,等.简易呼吸功能锻炼对肺癌手术患者围手术期肺功能的影响[J].中国肿瘤外科杂志,2018,10(4):225-227;232.
[2]宋勇.Ⅲ期非小细胞肺癌手术治疗患者预后的影响因素分析[J].中国实用医药,2019,14(1):25-26.
[3]邵茜茜,刘东英.肺癌患者肺叶切除术后症状群调查研究[J].护理学报,2018,25(18):1-4.
[4]Lai Y,Huang J,Yang M,et al.Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer:a randomized controlled trial[J].J Surg Res,2017,209:30-36.
[5]苏建华,车国卫.肺癌患者术前肺功能评定的现状与进展[J].中国肿瘤临床,2017,44(7):301-305.
[6]Lai Y,Su J,Qiu P,et al.Systematic short-term pulmonary rehabilitation before lung cancer lobectomy:a randomized trial[J].Interact Cardiovasc Thorac Surg,2017,25(3):476-483.
[7]Licker M,Karenovics W,Diaper J,et al.Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery:a randomized controlled trial[J].J Thorac Oncol,2017,12(2):323-333.
[8]李鹏飞,赖玉田,周坤,等.肺癌患者围手术期振动正压呼气训练有助于加速康复吗?[J].中国肺癌杂志,2018,21(12):890-895.
[9]陈惠英,黄德辉,刘衬云,等.容量控制通气与压力控制通气对老年肺癌肺叶切除术患者血流动力学影响的对比研究[J].中国临床医生杂志,2017,45(12):70-72.
[10]王静,李丽,韩辉,等.肺功能锻炼对阻塞性通气功能障碍肺癌患者肺功能及手术耐受性的影响[J].中华物理医学与康复杂志,2017,39(3):202-206.
[11]Fernandez FG,Falcoz PE,Kozower BD,et al.The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases:joint standardization of variable definitions and terminology[J].Ann Thorac Surg,2015,99(1):368-376.
[12]赖玉田,苏建华,杨梅,等.术前短期综合肺康复训练对肺癌合并轻中度慢性阻塞性肺病患者的影响:一项前瞻性随机对照试验[J].中国肺癌杂志,2016,19(11):746-753.
[13]Lai Y,Du H,Wang X,et al.Status and perspectives of clinical modes in surgical patients with lung cancer:a retrospective study[J].Medicine(Baltimore),2016,95(2):e2429.
[14]孙玉宏,于绍芬.呼吸功能训练护理改善老年肺癌患者术后疗效指标[J].中国老年保健医学,2015,13(3):111-112.
[15]郭志斌,赵洪林,李梅,等.简易呼吸功能锻炼对肺癌手术患者围手术期肺功能的影响[J].中国肿瘤外科杂志,2018,10(4):225-227;232.