摘要目的 探讨肺功能锻炼对不同程度阻塞性通气功能障碍肺癌患者肺功能及手术耐受性的影响.方法 对103例肺功能不能耐受手术的阻塞性通气功能障碍(轻度26例,中度53例,重度24例)肺癌患者进行肺功能强化训练,持续训练时间5～7d.于锻炼前、后对患者主要肺功能指标[包括肺活量(VC)、肺活量百分比(VC％)、用力肺活量(FVC)、用力肺活量百分比(FVC％)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积百分比(FEV1％)、最大自主通气量百分比(MVV％)、最大呼气流量百分比(PEF％)、第1秒钟用力呼气容积与用力肺活量比值(FEV1/FVC)、最大中期呼气流量百分比(MMEF％)]进行检测,并记录患者术后并发症发生情况.结果 本研究入选轻、中、重度通气功能障碍组患者经肺功能强化训练后,发现其肺功能指标VC、VC％、FVC、FVC％、FEV1、FEV1％、MVV％及PEF％均较入选时明显改善(P＜0.05);所有患者锻炼前、后其FEV1/FVC均无显著变化(P＞0.05);中度障碍组患者锻炼后其MMEF％较锻炼前明显改善(P＜0.05).轻、中、重度障碍组分别有19例(73.08％)、34例(64.15％)、8例(33.33％)患者达到手术要求并施以手术治疗,轻、重度障碍组和中、重度障碍组手术率间差异均具有统计学意义(P＜0.05).61例手术患者术后共有27例(44.26％)出现并发症,与呼吸功能正常的对照组术后并发症发生率(20.00％)间差异具有统计学意义(P＜0.05).结论 肺功能锻炼能有效提高阻塞性通气功能障碍肺癌患者手术耐受性,但患者术后风险仍明显高于通气功能正常肺癌患者.

abstractsObjective To study the effects of pulmonary function training on the lung function and surgical tolerance of lung cancer patients with different degrees of obstructive ventilatory defect.Methods Pulnonary function training was performed with 103 lung cancer patients with obstructive ventilatory defects (26 mild cases,53 moderate cases,24 severe cases).The duration of the intensive training was 5-7 days.Vital capacity (VC),vital capacity percentage (VC％),forced vital capacity (FVC),forced vital capacity percentage (FVC％),forced expiratory volume in one second (FEV1),percentage of the forced expiratory volume in one second (FEV1％),maximum voluntary ventilation percentage (MVV％),peak expiratory flow percentage (PEF％),fraction of the forced expiratory volume in one second (FEV1/FVC),and maximum mid-expiratory flow percentage (MMEF％) were measured before and after the training.Any postoperative complications were recorded.Results The average MMEF％ improved significantly among the moderate patients after their training.Eventually 19/26 patients (73.08％) in the mild group,34/53 patients (64.15％) in the moderate group,and 8/24 patients (33.33％) in the severe group met the requirements to undergo lung operations.These were significant differences among the groups.Among those operated on,27 (44.26％) suffered from postoperative complications,a significantly higher percentage than among the normal controls (20.00％).Conclusion Lung function exercises can improve the operation tolerance of lung cancer patients with obstructive ventilation dysfunction,but the risk of operating is still much higher than for patients with normal ventilation function.