运动训练对晚期肺癌放疗患者心肺运动功能及生存质量影响的临床研究  

A clinical study of the impact of exercise training on cardiorespiratory fitness and quality of life among advanced lung cancer patients under radiation therapy

作　　者：王丹 李瑾[2] 张明 高民[1,2] 陈猛 张一帆[2] 夏露露[3] 陈伟[2] WANG Dan;LI Jin;ZHANG Ming(Xuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical University,Xuzhou,Jiangsu,221010)

机构地区：[1]徐州医科大学附属徐州康复医院,江苏省徐州市221010 [2]徐州市中心医院,徐州医科大学徐州临床学院 [3]南京医科大学康达学院

出　　处：《中国康复医学杂志》2022年第4期501-509,共9页Chinese Journal of Rehabilitation Medicine

基　　金：徐州市引进临床医学专家团队项目(2018TD007);徐州市科技计划项目(KC18184,KC20136)。

摘　　要：目的:探讨依据心肺运动试验(cardiopulmonary exercise test,CPET)制定的个体化运动训练方案对肺癌患者放疗前、后心肺功能及生存质量的影响。方法:按随机数字表法将40例肺癌患者分为观察组(n=22)和对照组(n=18)。对照组予常规放疗及护理,观察组在此基础上进行个体化运动训练,每次45—60min,3次/周,平均训练14.36±3.36次,持续4.79±1.12周。所有入选患者分别在放疗前1天和结束后1天进行CPET和简明生存质量量表(SF-36)评估。结果:两组患者放疗前组间比较,各指标无显著性差异(P>0.05);放疗后,观察组峰值摄氧量(VO_(2peak))(ml/min、ml/min/kg、%pred)、无氧阈(AT)(ml/min)较对照组显著升高(P<0.05)。与放疗前比较,对照组患者放疗后VO_(2peak)显著下降,峰值功率(WR_(peak))降低,二氧化碳通气当量最低值(VE/VCO_(2nadir))增加,均具有显著性差异(P<0.05)。与放疗前比较,观察组放疗后VO_(2peak)、AT(ml/min)、WRpeak功率和分钟通气量以及峰值氧脉搏(peak O2 pulse)显著增加(P<0.05),VE/VCO_(2nadir)及VE/VCO_(2slope)显著降低(P<0.05)。两组放疗前、后的静态肺功能各项指标,组间、组内比较均无显著意义(P>0.05)。SF-36评估提示,放疗前,两组间各项指标比较无显著差异(P>0.05);放疗后,观察组生理职能、躯体疼痛、精力、社会功能、情感职能、精神健康各项得分均显著高于对照组(P<0.05)。观察组放疗前、后各项得分比较,差异无显著性意义(P>0.05);较放疗前,对照组精力、情感职能及精神健康得分均显著下降(P<0.05)。结论:放疗期间同步运动训练安全可行,有助于提高晚期肺癌患者运动能力,维持生存质量。CPET可用于科学评估放疗影响及制定个体化运动处方。Objective:To explore the effects of individualized exercise training program based on cardiopulmonary exercise test(CPET)assessment on cardiopulmonary function and quality of life of lung cancer patients before and after radiotherapy.Method:According to the result of random number table,40 patients with lung cancer were divided into observation group(n=22)and control group(n=18).The control group received conventional radiotherapy and nursing,and the observation group received individualized exercise training,45 to 60 minutes each time,3 times per week,with an average of 14.36±3.36 times,lasting for 4.79±1.12 weeks.All the enrolled patients were evaluated with CPET and SF-361 day before and 1 day after radiotherapy,respectively.Result:Before radiotherapy,there were no significant differences in each indicator between the two groups(P>0.05).After radiotherapy,the peak oxygen uptake(VO_(2peak))(ml/min,ml/min/kg,%pred)and anaerobic threshold(AT)(ml/min)in the observation group were significantly higher than that in the control group(P<0.05).In the control group,post-radiotherapy VO_(2peak) and peak work rate markedly decreased while VE/VCO_(2nadir) significantly increased,compared with those pre-radiotherapy data(P<0.05).In the observation group,significant increases were also found in post-radiotherapy VO_(2peak),AT(ml/min),peak work rate,peak minute ventilation and peak O_(2) pulse(P<0.05).Additionally,VE/VCO_(2) nadir and VE/VCO_(2slope) markedly decreased(P<0.05).All pre-and post-radiotherapy indexes of static lung function compared between and within the two groups were not significant(P>0.05).The result of SF-36 evaluation showed that there was no significant difference in each indicator between the two groups at baseline(P>0.05);After radiotherapy,the scores of physical function,physical pain,energy,social function,emotional function and mental health in the observation group were significantly higher than those in the control group(P>0.05).Compared within the observation group to pre-radiotherapy,post-radi

关 键 词：心肺运动试验 生存质量 运动康复 肺癌 放射治疗 

分 类 号：R493[医药卫生—康复医学] R734.2[医药卫生—临床医学]