摘要目的 探讨院前预康复策略对肺部肿瘤患者的实施效果.方法 选取2018年7月至2019年4月在天津医科大学肿瘤医院肺部肿瘤科收治的行胸外科手术患者68例,根据就诊先后顺序分为对照组及院前预康复组各34例.对照组按照常规胸外科手术前准备,院前预康复组接受以家庭为基础的预康复干预.比较2组患者干预前、术前1 d、术后30 d 6分钟步行距离(6MWD)、医院焦虑抑郁评分(HADS)、第1秒用力呼气体积(FEV1)、用力肺活量(FVC),以及术后胸腔引流情况及术后并发症的差异.结果 院前预康复组术前1 d6MWD、FEV1、FVC分别为(611.08 ± 47.13)m、(2.48 ± 0.51)L、(3.43 ± 0.48)L,对照组分别为(520.26 ± 57.33)m、(2.19 ± 0.38)L、(3.17 ± 0.58)L,2组比较差异有统计学意义(t=7.136、2.659、2.014,P＜0.05).院前预康复组术后30 d 6MWD、FEV1、FVC分别为(540.27 ± 85.73)m、(2.07 ± 0.46)L、(2.98 ± 0.67)L,对照组分别为(488.86 ± 75.04)m、(1.82 ± 0.51)L、(2.42 ± 0.58)L,2组比较差异有统计学意义(t=2.631、2.122、3.685,P＜0.05).院前预康复组及对照组术后首日胸腔引流量分别为(162.35 ± 43.08)、(191.42 ± 69.11)ml,2组比较差异有统计学意义(t=2.081,P＜0.05).院前预康复组术后肺部感染、肺不张、心律失常的发生率分别为0、2.9%(1/34)、0,对照组分别为2.9%(1/34)、8.8%(3/34)、14.7%(5/34),院前预康复组术后心律失常发生率明显小于对照组(P＜0.05).结论 院前预康复策略能够有效改善肺部肿瘤患者围手术期的功能状态及预后,同时在一定程度上减少术后并发症的发生,值得临床进一步推广.

abstractsObjective To explore the practical effect of pre-hospital prehabilitation strategy in pulmonary tumor patients. Methods A total of 68 patients receiving thoracic surgery in Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute & Hospital, during July 2018 to April 2019, were divided into pre-hospital prehabilitation group (n=34) and control group (n=34), according to the order of outpatient. Patients in control group received routine guidance before thoracic surgery, and those in pre- hospital prehabilitation group received a home- based preoperative intervention. The differences of 6-minute walking distance (6MWD), hospital anxiety and depression score (HADS), forced expiratory volume at the first second (FEV1), forced vital capacity (FVC), postoperative thoracic drainage and complications were compared between the two groups. Results The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (611.08±47.13) m, (2.48±0.51) L and (3.43±0.48) L on one day preoperatively, respectively, while in the control group, the values were (520.26±57.33) m, (2.19± 0.38) L and (3.17±0.58) L, respectively, with statistically significant differences, t=7.136, 2.659, 2.014, P<0.05. The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (540.27±85.73) m, (2.07±0.46) L and (2.98±0.67) L at 30 days postoperatively, respectively, while in the control group, the values were (488.86±75.04) m, (1.82±0.51) L and (2.42±0.58) L, respectively, with statistically significant differences, t=2.631, 2.122, 3.685, P<0.05. The thoracic drainage of pre-hospital prehabilitation group and control group were (162.35 ± 43.08) ml and (191.42 ± 69.11) ml, respectively, t=2.081, P<0.05. In addition, the occurrence rates of complications such as pulmonary infection, pulmonary atelectasis and arrhythmia were 0.0%(0/34), 2.9%(1/34), 0.0%(0/34) in the pre-hospital prehabilitation group, while those were 2.9%(1/34), 8.8%(3/34), 14.7%(5/34) in the control group, pre-hospital prehabilitation group had a significant reduction in the occurrence of arrhythmia (P<0.05). Conclusions The pre- hospital prehabilitation strategy significantly improve the perioperative functional status and prognosis of lung cancer patients, and reduce the occurrence of postoperative complications to a certain extent, which is worth of being further promoted clinically.