文章摘要

多学科肺康复干预在肺癌合并中重度慢性阻塞性肺疾病患者围手术期中的应用

作者: 1王慧敏, 1王静, 1吴红霞
1 安阳地区医院心胸外二科,河南 安阳 455000
通讯: 王慧敏 Email: wanghuimin0784@126.com
DOI: 10.3978/j.issn.2095-6959.2018.04.019

摘要

目的:探讨多学科肺康复干预在肺癌合并中重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者围手术期中的运用价值。方法:将2015年4月至2016年11月在安阳地区医院接受手术治疗的64例肺癌合并中重度COPD患者随机分为对照组与观察组,每组各32例。其中对照组采用常规的围手术管理方案;观察组采用多学科肺康复干预措施,包括术前为期2周的强化运动锻炼、呼吸功能锻炼和口服营养补充干预,术后合理止痛、早期行呼吸功能锻炼、运动锻炼和口服营养补充。收集两组肺功能指标、血清营养学指标及术后手术相关指标变化情况。结果:观察组患者在术前1 d时秒用力呼气量占预计值百分比(FEV1%pre)、第1秒用力呼气容积占用力肺活量比值(FEV1/FVC)和最大自主通气量(maximal voluntary ventilation,MVV)均明显优于对照组,观察组术后3 d的血清白蛋白(serum albumin,ALB)、前清蛋白(prealbumin,PA)、转铁蛋白(transferrin,TF)和纤维连接蛋白(fibronectin,FN)水平均明显优于对照组。观察组患者术后平均胸管停留时间和平均住院天数均明显缩短,且术后肺不张、肺部感染及呼吸衰竭等肺部并发症发生率均明显低于对照组。结论:多学科肺康复干预可有效提升肺功能低下肺癌患者术前肺功能储备,改善术后的营养学状态,降低术后并发症发生率。
关键词: 肺通气功能障碍;慢性阻塞性肺疾病;多学科;肺癌;肺康复

Application of multidisciplinary pulmonary rehabilitation intervention to lung cancer patients with moderate and severe chronic obstructive pulmonary disease

Authors: 1WANG Huimin, 1WANG Jing, 1WU Hongxia
1 Second Department of Cardiothoracic Surgery, Anyang District Hospital, Anyang Henan 455000, China

CorrespondingAuthor: WANG Huimin Email: wanghuimin0784@126.com

DOI: 10.3978/j.issn.2095-6959.2018.04.019

Abstract

Objective: To discuss the value of multidisciplinary pulmonary rehabilitation intervention to lung cancer patients with moderate and severe chronic obstructive pulmonary disease (COPD). Methods: A total of 64 lung cancer patients with moderate and severe COPD who accepted operation in our hospital from April 2015 to December 2016 were divided into a control group and an observation group randomly. Each group had 32 patients. The control group adopted routine preoperative management scheme; in contrast, the observation group received multidisciplinary pulmonary rehabilitation intervention, including 2 weeks of intensive exercise, breathing exercises and oral nutrition supplement intervention, postoperative reasonable analgesia, early respiratory function exercise, exercise and oral nutrition supplement. lung function indexes, serum nutritional indexes and postoperative related indexes were collected before and after intervention were collected and compared. Results: The first second forced expiratory volume of vital capacity ratio expected (FEV1%pre), the first second forced expiratory volume ratio of forced vital capacity (FEV1/FVC) and maximal voluntary ventilation (MVV) in the observation group were significantly better than those in the control group in the first days before operation. The serum albumin (ALB), prealbumin (PA), transferrin (TF) and fibronectin (FN)of the observation group were significantly better than the control group in the third days after operation. Moreover, average postoperative thoracic duct stay time and average hospital stay length of the observation group were shortened obviously; the occurrence rates of postoperative pulmonary atelectasis, pulmonary infection and respiratory failure were evidently lower than those of the control group. Conclusion: Multidisciplinary pulmonary rehabilitation intervention can effectively improve the pulmonary functional status of lung cancer patients with moderate and severe pulmonary ventilation function disorder, improve postoperative nutritional status, and reduce the occurrence rate of postoperative complications. Therefore, this method is worthy of being promoted in clinic.
Keywords: pulmonary ventilatory dysfunction; chronic obstructive pulmonary disease; multidisciplinary; lung cancer; pulmonary rehabilitation

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