综合物理治疗对肺癌合并慢性阻塞性肺疾病患者术后肺功能的影响  

The effects of physiotherapy on pulmonary function in COPD patients with primary lung cancer undergoing lung resection

作　　者：倪高顺 陈洋[1] NI Gaoshun CHEN Yang(Department of Respiratory Medicine, Shangluo Central Hospital, Shangluo, Shannxi 726000, P.R.Chin)

机构地区：[1]商洛市中心医院呼吸内科,陕西商洛726000

出　　处：《中国呼吸与危重监护杂志》2017年第4期318-323,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的评估综合物理治疗对肺癌合并慢性阻塞性肺疾病(简称慢阻肺)患者肺切除术或叶切除术后肺功能的影响。方法选取2005年1月至2014年5月因肺癌接受肺切除术或肺叶切除术的慢阻肺合并肺癌患者,根据术前是否接受物理治疗分为综合物理治疗组(A组,55例)和未接受综合物理治疗组(B组,43例)。比较A组入院时(T1时间点)和综合物理治疗后(T2时间点)的肺功能的变化,同时比较A、B两组患者手术后(T3时间点)肺功能和临床特征的变化。结果 A组患者进行术前综合物理治疗后第1秒用力呼气容积(FEV_1)、肺活量(VC)、50%肺活量位最大呼气流速(FEF50)和25%肺活量位最大呼气流速(FEF25)比基线值分别增加16.96%、14.75%、20.69%和13.79%,6分钟步行距离得到显著改善。术后FEV_1和VC显著降低,小气道功能和临床特征显著恶化,在Δ[T2-T1]阶段,不同程度FEV_1%pred患者间肺功能变化差异无统计学意义;在Δ[T2-T3]阶段,FEV_1%pred≥80%患者和50%≤FEV_1%pred<80%患者FEF50和FEF25变化程度大于FEV_1%pred<50%的患者。肺叶切除术患者肺功能B组患者低于A组患者(FEV_1:10.24%vs.22.44%;VC:10.13%vs.20.87%);在肺切除术患者中也存在相似的差异,但差异较小(FEV_1:36.33%vs.36.78%;VC:37.23%vs.38.98%)。结论综合物理治疗对于改善肺癌合并慢阻肺患者肺切除术或叶切除术后肺功能有重要意义。Objective To assess the effects ofphysiotherapy on pulmonary function in COPD patients with lung cancer after lobectomy or pneumonectomy. Methods Fifty-five COPD patients with lung cancer undergoing lobectomy or pneumonectomy from January 2005 to May 2014 were recruited in the study. They were divided into group A received comprehensive physiotherapy before surgery and group B without comprehensive physiotherapy before surgery. The changes of lung function and tolerance were compared before physiotherapy （T1 time point） and after physiotherapy （T2 time point） in the group A, and between two groups before lung resection （T2 time point） and after lung resection （T3 time point）. Results In group A, the forced expiratory volume in one second （FEV1）, vital capacity （VC）, peak expiratory flow at 50% of vital capacity （FEFS0） and FEF25 increased significantly respectively by 16.96%, 14.75%, 20.69% and 13.79% compared with those before physiotherapy. Meanwhile, six-minutes walking distance （6MWD） achieved a significant improvement. After resection of lung, FEV1 and VC appeared to reduce, and pulmonary small airway function, tolerance, and clinical features deteriorated significantly. The differences between T2 and T1 in FEV1, FEF50 and FEF25 in the patients with FEV1%pred≥80% and 50%-80% were similar with those in the patients with FEVt%pred〈50%. The differences between T2 and T3 in FEFSO and FEF25 in the patients with FEV1%pred≥80% and 50%-80% were higher than those with FEV,%pred〈50%. For the patients with lobectomy, FEV1 and VC in the group B were lower than those in the group A （FEV1： 10.24% vs. 22.44%; VC： 10.13% vs. 20.87%）. For the patients with pulmonary resection, FEV1 and VC hadlittle differences （FEV1： 36.33% vs. 36.78%; VC： 37.23% vs. 38.98%）. Conclusion Physiotherapy is very important for the preoperative treatment and postoperative nursing of COPD patients with primary lung cancer.

关 键 词：物理治疗 肺癌 慢性阻塞性肺疾病 叶切除术 肺切除术 

分 类 号：R563.9[医药卫生—呼吸系统] R734.2[医药卫生—内科学]