摘要
目的:探讨术前短期中高强度下肢运动训练对低肺功能肺癌患者肺切除手术耐受性的影响。方法:采用随机单盲设计,将61例可切除肺癌合并重度慢性阻塞性肺病患者,根据美国胸科医师协会肺切除术前评估指南分为可手术A组和不可手术B组;A组再随机分为A1亚组(训练亚组)和A2亚组(对照组)。A1亚组和B组术前予每周5次、连续2周、强度达60%—80%峰值氧摄量VO2max的踏车运动训练,辅以胸腹联合缩唇呼吸训练。比较训练前后静态肺功能和运动心肺功能的变化;训练后重新评估B组手术风险;比较训练A1亚组和对照A2组肺切除术后并发症情况。结果:训练后,在A1亚组,心肺功能指标:肺一氧化碳弥散量DLCO(P=0.003)、VO2max(P<0.001)、无氧阈AT(P=0.008)、氧脉VO2max/HR(P<0.001)较训练前显著改善;在B组,心肺功能指标:用力肺活量FVC(P<0.001)、分钟最大通气量MVV(P=0.001)、DLCO(P<0.001)、最大功率W(P=0.004)、VO2max(P<0.001)、AT(P=0.002)、VO2max/HR(P=0.001)、峰值通气量VEmax(P=0.015)、无氧阈时CO2通气当量VE/VCO2@AT(P=0.003)和运动后经皮血氧饱和度SPO2%(P=0.002)均较训练前显著改善;B组中59%(10/17)患者达手术标准;训练A1亚组较对照A2组,肺切除术后氧疗时间(P=0.04)、机械通气时间(P=0.036)和住院天数(P=0.025)均显著缩短。结论:术前短期中高强度下肢运动训练能有效、可行地提高低肺功能肺癌患者心肺功能适应性,有助于肺切除术后康复。
Objective：To investigate the effects of preoperatively short-term and moderate-high intensity lower extremity ex- ercise training （ET） on surgery tolerability in lung cancer patients with impaired pulmonary function. Method：In a randomized single blinded design, 61 resectable lung cancer patients with severe chronic obstruc- tive pulmonary disease （COPD） were divided into operable group A and inoperable group B, according to American College of Chest Physicians （ACCP） guidelines on lung resection. Group A was randomly divided in- to subgroup A1 and subgroup A2. Both subgroup A1 and group B preoperatively performed structured ET con- sisted of 5 endurance cycle ergometry sessions per week at intensities varying from 60% to 80% of baseline maximal oxygen uptake （VO2max）, along with thoraco-abdominal and pursed lip breathing exercises for two weeks. Subgroup A2 as a control of subgroup A1, without ET. Result：On completion of ET, significant improvements were observed in the cardiopulmonary function parameters： for subgroup A in DLCO （diffusion capacity for carbon monoxide of lung,P=0.003）,VO2max （P〈0.001）, AT （anaerobic threshold, P=0.008） and VO2max/HR （oxygen pulse,P〈0.001）; for group B in FVC （forced vital capacity, P〈0.001）,MVV （maximal voluntary ventilation,P=0.001）,DLCO （P〈0.001）,Wmax （maximal power,P=-0.004）, VO2max （P〈0.001）,AT （P=0.002）, VO2max/HR （P=0.001）,VEmax （maxium minute ventilation,P=0.015）, VE/ VCOa@AT （ventilator equivalent for CO2 at AT, PP=0.003） and after-exercise SPO2% （transcutaneous oxygen satu- ration, P=0.002）. Patients in group B re-entered functional criteria and 59 percent （10/17） of patients underwent lobectomy. Compared with the control subgroup A2, patients in subgroup A1 presented shorter postoperative oxygen supplement duration （P=0.04）, mechanical ventilation period （P=0.036）, and hospital stay （P=0.025）. Conclusion：Preoperative short-term and moderate-high intensity lower extremity exercise training is a feasible and effective intervention to improve cardiopulmonary fitness for better postoperative recovery in lung cancer patients with severe COPD.
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2013年第7期619-623,共5页
Chinese Journal of Rehabilitation Medicine
基金
广东省卫生厅医学科学研究基金资助项目(A2009208)
关键词
肺康复
肺癌
慢性阻塞性肺疾病
肺切除术
pulmonary rehabilitation
lung cancer
chronic obstructive pulmonary disease
lung resection
