肺癌合并慢阻肺患者术后运动康复获益探究  

Study on the Benefit of Postoperative Exercise Rehabilitation in Patients with Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease

作　　者：余中华 谢国省[1] 秦昌龙[1] 邱小明 Zhonghua YU;Guosheng XIE;Changlong QIN;Xiaoming QIU(West China Hospital,Sichuan University,Chengdu 610000,China)

机构地区：[1]四川大学华西医院,成都610000

出　　处：《中国肺癌杂志》2022年第1期14-20,共7页Chinese Journal of Lung Cancer

摘　　要：背景与目的慢性阻塞性肺病(chronic obstructive pulmonary diseases,COPD)影响全世界范围内45%-63%的肺癌患者,合并COPD的肺癌患者心肺功能降低,围术期风险增加,且术后运动耐力和肺功能较常规肺癌患者下降幅度更大。已有研究表明术后运动训练可以改善未经选择的肺癌患者运动耐力,但合并COPD的肺癌患者是否也能从术后运动训练中获益尚不清楚,本研究拟探究术后运动训练对肺癌合并COPD患者运动耐力、日常活动能力和肺功能的影响。方法前瞻性分析2020年8月5日-2021年8月25日于四川大学华西医院肺癌中心行肺切除术治疗的非小细胞肺癌(non-small cell lung cancer,NSCLC)合并COPD患者74例,随机分为运动组和对照组;两组患者术后第1周接受常规术后康复,从第2周开始对照组给予常规护理,运动组在此基础上进行术后运动康复训练,为期2周。术前3天进行基线评估,术后3周进行终点评估。结果两组患者的运动耐力,日常活动能力和肺功能测试结果均从基线到终点有所下降,但在手术和干预方案后,运动组心肺运动试验的最大耗氧量和6分钟步行试验的步行距离均显著优于对照组[(13.09±1.46)mL/kg/min vs(11.89±1.38)mL/kg/min,P=0.033;(297±46)m vs(243±43)m,P=0.041]。运动组平均微信计步数量也显著优于对照组(4,381±397 vs 3,478±342,P=0.035)。运动组用力肺活量(forced vital capacity,FVC)和一秒用力呼气容积(forced expiratory volume in one second,FEV;)均优于对照组,但差异未达到统计学显著水平[(1.76±0.19)L vs(1.60±0.28)L,P=0.084;(1.01±0.17)L vs(0.96±0.21)L,P=0.467]。结论术后运动康复训练可以改善肺癌合并COPD患者运动耐力和日常活动能力,促进术后康复。Background and objective Chronic obstructive pulmonary diseases(COPD)affects 45%-63%of lung cancer patients worldwide.Lung cancer patients complicated with COPD have decreased cardiopulmonary function and increased perioperative risk,and their postoperative exercise endurance and lung function are significantly lower than those with conventional lung cancer.Previous studies have shown that postoperative exercise training can improve the exercise endurance of unselected lung cancer patients,but it is unclear whether lung cancer patients with COPD can also benefit from postoperative exercise training.This study intends to explore the effects of postoperative exercise training on exercise endurance,daily activity and lung function of lung cancer patients with COPD.Methods Seventy-four patients with non-small cell lung cancer(NSCLC)complicated with COPD who underwent pneumonectomy in the lung cancer center of West China Hospital of Sichuan University from August 5,2020 to August 25,2021 were prospectively analyzed.They were randomly divided into exercise group and control group;The patients in the two groups received routine postoperative rehabilitation in the first week after operation,and the control group was given routine nursing from the second week.On this basis,the exercise group received postoperative exercise rehabilitation training for two weeks.Baseline evaluation was performed 3 days before operation and endpoint evaluation was performed 3 weeks after operation.Results The exercise endurance,daily activity and pulmonary function test results of the two groups decreased from baseline to the end point.However,after the operation and intervention program,the maximum oxygen consumption of Cardiopulmonary Exercise Test and the walking distance of 6-Minute Walking Test in the exercise group were significantly better than those in the control group[(13.09±1.46)mL/kg/min vs(11.89±1.38)mL/kg/min,P=0.033;(297±46)m vs(243±43)m,P=0.041].The average number of we-chat steps in the exercise group was also significan

关 键 词：肺肿瘤 术后康复 运动耐力 肺功能 微信计步 

分 类 号：R734.2[医药卫生—肿瘤] R563.9[医药卫生—临床医学]