多学科肺康复干预在肺癌合并...塞性肺疾病患者中的应用效果_吕鹏鹏.pdf

癌症进展2022 年 12 月第 20 卷第 24 期ONCOLOGY PROGRESS,Dec 2022 V ol.20,No.24*论著*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中的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中的应用效果应用效果吕鹏鹏#，马腾，张明月，袁园平煤神马医疗集团总医院呼吸与危重症医学科，河南 平顶山 4670000摘要摘要：目的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患者中的应用效果。方法方法选取122例肺癌患者，均接受胸腔镜下肺癌根治术，依据干预方式的不同分为对照组和观察组，每组61例，对照组患者给予常规护理干预，观察组患者在此基础上给予多学科肺康复干预。比较两组患者的营养指标白蛋白（ALB）、前清蛋白（PA）、转铁蛋白（TF）和纤维连接蛋白（FN）、生活质量欧洲癌症研究与治疗组织生命质量测定量表（EORTC QLQ-C30）、肺功能指标第1秒用力呼气容积占预计值的百分比（FEV1%pred）、用力肺活量占预计值的百分比（FVC%pred）、最大通气量占预计值的百分比（MVV%pred）、术后住院时间、术后胸管留置时间及不良反应发生情况。结果结果术后3天，两组患者ALB、PA、TF、FN水平均低于本组术前1天，但观察组患者ALB、PA、TF、FN 水平均高于对照组，差异均有统计学意义（P0.05）。术后 1 周，两组患者 FEV1%pred、FVC%pred、MVV%pred水平均低于本组入院时，但观察组患者FEV1%pred、FVC%pred、MVV%pred水平均高于对照组，差异均有统计学意义（P0.05）。干预后3个月，两组患者EORTC QLQ-C30量表各维度评分均高于本组干预前，且观察组患者EORTC QLQ-C30量表各维度评分均高于对照组，差异均有统计学意义（P0.05）。观察组患者术后胸管留置时间和术后住院时间均明显短于对照组，并发症总发生率明显低于对照组，差异均有统计学意义（P0.01）。结论结论多学科肺康复干预可有效改善肺癌合并中重度慢性阻塞性肺疾病患者围手术期的营养状态，提高患者肺功能，并降低术后并发症发生率，改善生活质量，促进术后康复。关键词关键词：慢性阻塞性肺疾病；肺癌；多学科肺康复干预；生活质量中图分类号中图分类号：R R734734.2 2文献标志码文献标志码：AdoiAdoi：10.11877/j.issn.1672-1535.2022.20.24.24Effect of multidisciplinary pulmonary rehabilitation intervention on lung cancerEffect of multidisciplinary pulmonary rehabilitation intervention on lung cancerpatients with moderate to severe chronic obstructive pulmonary diseasepatients with moderate to severe chronic obstructive pulmonary diseaseLYU Pengpeng#,MATeng,ZHANG Mingyue,YUAN YuanDepartment of Respiratory and Critical Care Medicine,General Hospital of Pingmei Shenma Medical Group,Pingdingshan 467000,He nan,ChinaAbstract:ObjectiveAbstract:ObjectiveTo explore the effect of multidisciplinary pulmonary rehabilitation intervention on lung cancerpatients with moderate to severe chronic obstructive pulmonary disease.MethodMethodA total of 122 patients with lung can-cer were selected to undergo thoracoscopic radical resection of lung cancer.They were divided into control group and ob-servation group according to the different intervention methods,with 61 patients in each group.The patients in the controlgroup were given routine nursing intervention,while the patients in the observation group were given multidisciplinarylung rehabilitation intervention on this basis.The nutritional indicators albumin(ALB),prealbumin(PA),transferrin(TF),fibronectin(FN),quality of life European Organization for Research and Treatment of Cancer quality of life ques-tionnaire core-30(EORTC QLQ-C30),pulmonary function indicators forced expiratory volume in one second predicted(FEV1%pred),forced vital capacity predicted(FVC%pred),maximal voluntary ventilation predicted(MVV%pred),post-operative hospital stay,postoperative chest tube retention time and adverse reactions of the two groups were compared.ResultResultOn the 3rd day after operation,the levels of ALB,PA,TF and FN in the two groups were lower than those on the1st day before operation,but the levels of ALB,PA,TF and FN in the observation group were higher than those in thecontrol group,the differences were statistically significant(P0.05).One week after operation,the FEV1%pred、FVC%pred、MVV%pred levels of patients in the two groups were lower than those in the group at admission,but the FEV1%pred、FVC%pred、MVV%pred levels of patients in the observation group were higher than those in the control group,thedifferences were statistically significant(P0.05).Three months after the intervention,the scores of each dimensionEORTC QLQ-C30 in both groups were higher than those before the intervention,and the scores of each dimensionEORTC QLQ-C30 in the observation group were higher than those in the control group,the differences were statisticallysignificant(P0.05).Postoperative chest tube retention time and postoperative hospital stay in the observation group were#通信作者（corresponding author），邮箱：2571癌症进展2022年12月第20卷第24期significantly shorter than those in the control group,and the total incidence of complications was significantly lower thanthat in the control group,the differences were statistically significant(P0.01).ConclusionConclusionMultidisciplinary pulmo-nary rehabilitation intervention can effectively improve the nutritional status of lung cancer patients with moderate to se-vere chronic obstructive pulmonary disease during the perioperative period,improve the pulmonary function of patients,reduce the incidence of postoperative complications,improve the quality of life,and promote postoperative rehabilitation.Key words:Key words:chronic obstructive pulmonary disease;lung cancer;multidisciplinary pulmonary rehabilitation interven-tion;quality of lifeOncol Prog,2022,20(24)肺癌是临床较常见的恶性肿瘤之一，具有高发病率、高病死率，中国肺癌发病率、病死率均居恶性肿瘤首位1。手术可以有效切除肿瘤组织，改善患者的预后，随着胸腔镜等微创技术的应用，微创手术成为肺癌的首选治疗方式2。由于通气量不足、运动能力下降，肺癌合并中重度慢性阻塞性肺疾病患者的肺功能较差，手术风险较高，可诱发肺不张、肺部感染等并发症，不利于患者的预后，因此，需要采取一定的干预手段保证手术的顺利进行并改善患者的预后3。多学科肺康复干预是一种以多种学科交叉为基础的、以运动锻炼为核心的综合康复干预，能够促进患者肺功能的恢复，有利于患者的预后4。本研究旨在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患者中的应用效果，现报道如下。1 1资料与方法资料与方法1 1.1 1 一般资料一般资料选取2020年3月至2022年6月平煤神马医疗集团总医院收治的肺癌患者。纳入标准：符合中华医学会肺癌临床诊疗指南（2018版）5中肺癌的诊断标准，且经病理检查确诊为肺癌；符合慢性阻塞性肺疾病