非小细胞肺癌患者术前肺康复训练前后血清肺表面活性蛋白D(SP-D)改变与术后肺部并发症相关性的随机对照试验  

Preoperative pulmonary rehabilitation training to reduce the serum surfactant protein D (SP-D) level and postoperative pulmonary complications of lung cancer surgery with high risk factors:A randomized controlled trial

作　　者：高珂[1,2] 赖玉田 黄健[1] 王一帆[1] 王晓玮[2] 车国卫[1] 

机构地区：[1]四川大学华西医院胸外科,成都610041 [2]成都市第二人民医院胸心外科,成都610017

出　　处：《中国胸心血管外科临床杂志》2017年第5期330-337,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省科技厅基金(2015SZ0158);四川省卫生和计划生育委员会基金(16PJ033)

摘　　要：目的探讨肺康复训练前后肺癌患者血清肺表面活性蛋白D(SP-D)改变与术后肺部并发症(postoperative pulmonary complications,PPC)的相关性。方法纳入华西医院胸外科2015年3~12月连续收治的合并高危因素且行手术治疗的非小细胞肺癌患者80例,随机分为康复组[36例,男25例、女11例,平均年龄(63.98±8.32)岁]和对照组[44例,男32例、女12例,平均年龄(64.58±6.71)岁]。康复组行1周的术前肺康复训练,分析两组患者术后PPC、血清SP-D浓度。结果康复组PPC发生率低于对照组,且差异有统计学意义(5.56%vs.22.73%,P=0.032),康复组肺康复前后血清SP-D水平下降幅度[(30.75±5.57)ng/ml vs.(24.22±3.08)ng/ml高于对照组(31.16±7.81)ng/ml vs.(30.29±5.80)ng/ml,P=0.012];非PPC组术前血清SP-D水平下降幅度显著高于PPC组(P=0.012)。结论术前肺康复训练可以降低肺癌合并高危因素患者术后并发症发生率,血清SP-D水平变化程度可作为肺康复训练的评价指标。Objective To research the relationship between decrease of serum surfactant protein D （SP-D） level reduced by pulmonary rehabilitation training and postoperative pulmonary complications （PPC）. Methods From May 2015 through December 2015, 80 consecutive non-small cell lung cancer （NSCLC） patients with surgical treatment in West China Hospital, who were at least with a high risk factor, were randomly divided into two groups including a group R and a group C. There were 36 patients with 25 males and 11 females at age of 63.98±8.32 years in the group R and 44 patients with 32 males and 12 females at age of 64.58±6.71 years in the group C.The group R underwent an intensive preoperative pulmonary rehabilitation （PR） training for one week, and then with lobectomy. The group C underwent only lobectomy with conventional perioperative managements. Postoperative pulmonary complications, average days in hospital, other clinic data and the serum SP-D level in a series of time from the date of admission to discharge （5 time points） were analyzed. Results The incidence of PPC in the group R was 5.56%（2/36）,which was lower than that in the group C （P=0.032）. The descender of the serum SP-D level of the patients in the group R （30.75±5.57 ng/mlvs. 24.22±3.08 ng/ml） was more obvious than that in the group C （31.16±7.81 ng/mlvs. 30.29±5.80 ng/ml,P=0.012）. The descender of the serum SP-D level of the patients with PPC was more obvious than that of patients without PPC （P=0.012）. Conclusion The preoperative PR training could reduce the PPC of lung cancer surgery with high risk factors. The serum SP-D level could reflect the effect of preoperative pulmonary rehabilitation training.

关 键 词：术前肺康复训练 肺表面活性蛋白D(SP-D) 肺部并发症 肺癌 

分 类 号：R734.2[医药卫生—肿瘤]