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目的 评价术前肺康复在肺癌患者中的应用效果.方法 计算机检索Cochrane Library、Web of Science、Pubmed、Embase、知网、万方、维普和生物医学文献数据库,搜索术前肺康复应用于肺癌手术患者的随机对照研究(RCT)或类实验研究,检索时限均为1990年—2017年.由2名研究者独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 共纳入16项研究,包括904例患者,其中8项RCT,8项类实验.Meta分析结果显示,术前肺康复组患者术前第1秒用力呼气量(FEV1)增加(MD=0.20,95%CI:0.02~0.37,P=0.03)、术前用力肺活量(FVC)增加(MD=0.22,95%CI:0.05~0.38,P=0.009)、术前6 min步行实验距离(6MWT)增加(MD=44.07,95%CI:33.88~54.27,P<0.001)、术后住院时间缩短(MD=-2.28,95%CI:-2.77~1.79,P<0.001)及术后肺部并发症发生率降低(OR=0.32,95%CI:0.22~0.49,P<0.001).结论 术前肺康复能改善肺癌患者术前肺功能,缩短患者术后住院时间,降低术后肺部并发症发生率.

Objective To evaluate the efficacy of preoperative pulmonary rehabilitation in patients with lung cancer. Methods We searched Cochrane Library, Web of Science, Pubmed, Embase, CNKI, Wan Fang Date, Vip Date and CBM to collect randomized controlled trials (RCTs) or quasi-experimental study about perioperative pulmonary rehabilitation applied in lung cancer patients, the retrieval time was from 1990 to 2017. The data was analyzed by RevMan 5.3 software after two researchers independently screened the literature, extracted the data, and evaluated the biased risk of inclusion studies. Results A total of 16 studies were included, including 904 patients, and 8 of them were RCT, and 8 quasi-experimental studies. The results of meta-analysis showed that patients after preoperative pulmonary rehabilitation their the first-second forced expiratory volume (FEV1) was increased (MD=0.20, 95%CI: 0.02-0.37, P=0.03), preoperative forced vital capacity (FVC) was increased (MD=0.22,95%CI:0.05-0.38,P=0.009), preoperative distance of 6-minute walking test (6MWT) was increased (MD=44.07, 95%CI: 33.88-54.27, P<0.001), the postoperative hospital stay in the preoperative pulmonary rehabilitation group was shortened (MD=-2.28, 95%CI: -2.77-1.79, P<0.001) and the incidence of postoperative pulmonary complications was reduced (OR=0.32,95%CI:0.22-0.49, P< 0.001). Conclusions Preoperative pulmonary rehabilitation can improve lung function of patients with lung cancer, shorten the time of postoperative hospitalization and reduce the incidence of postoperative pulmonary complications.