目的 探讨院前家庭肺康复在肺癌合并慢性阻塞性肺疾病患者加速康复中的应用效果。方法 采用便利抽样法,将2019年12月—2020年12月收治的130例肺癌合并慢性阻塞性肺疾病患者按随机数字表法分为试验组和对照组。试验组在加速康复管理方案的基础上应用院前家庭肺康复方案,对照组给予加速康复管理方案。两组入院后第2天行手术治疗,全程运用加速康复方案。比较两组肺功能、6 min步行试验、峰流速、自我管理分值、术后并发症发生率、抗生素使用时间、住院时间和住院费用的差异。结果 实施过程中试验组脱落2例,最终试验组完成67例、对照组61例。干预后试验组中度慢性阻塞性肺疾病患者术后抗生素使用时间缩短（Z=-2.408,P=0.016）;每日峰流速均值显著增加（F=152.870,P<0.001）;自我管理总分提高（Z=-6.795,P<0.001）;术后并发症发生率、住院时间、住院费用降低（P<0.05）;试验组中度慢性阻塞性肺疾病患者术前肺功能提高（P<0.05）;6 min步行试验结果比较,差异无统计学意义（P>0.05）。结论 院前家庭肺康复训练有助于改善患者肺功能,提高峰流速,提升患者的自我管理能力,减少抗生素使用时间;在肺癌合并中度慢性阻塞性肺疾病患者中效果更为显著,有助于降低术后并发症的发生率,缩短住院时间,降低住院费用。
Objective To explore the effect of prehospital home-based pulmonary rehabilitation training on enhanced recovery after surgery（ERAS） in patients with lung cancer combined with chronic obstructive pulmonary disease（COPD）. Methods From December 2019 to December 2020,130 patients with lung cancer combined with COPD were divided into experimental group and control group according to random number table. The experimental group received prehospital pulmonary rehabilitation training intervention on the basis of the ERAS program,and the control group was provided with the ERAS program. The patients received surgery at the second day after admission and the ERAS program was performed through the entire process. Lung function,6-minute walk test,peak flow rate,self-management score,incidence of postoperative complications,duration of antibiotic use,length of hospital stay,and hospitalization cost were compared between the two groups. Results In the process of implementation,2 cases were dropped out in the experimental group. Finally we had 67 cases in the experimental group and 61 cases in the control group. Compared with the control group,the duration of antibiotic use in the experimental group for patients with moderate COPD after surgery was shorter（Z=-2.408,P=0.016）. The mean daily peak velocity was significantly increased（F=152.870,P<0.001). The total score of self-management was increased（Z=-6.795,P<0.001). The incidence of postoperative complications,length of hospital stay and hospitalization cost were decreased（P<0.05）. Preoperative lung function of patients with moderate COPD was improved after intervention and the difference was statistically significant（P<0.05）. However the difference in the 6-minute walk test was not statistically significant（P>0.05）. Conclusion Prehospital home-based pulmonary rehabilitation training can improve patients' lung function,increase peak flow rate,improve patient self-management ability and reduce antibiotic use time. It is more effective in patients with lung cancer and moderate COPD. Furthermore,it can also help reduce the incidence of postoperative complications,shorten the length of hospital stay,thereby reduce the cost of hospitalization.
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