摘要目的 探讨肺康复运动训练对非手术肺癌患者呼吸运动功能、中长期生活质量、生存状况及并发症的影响.方法 采用随机数字表法将88例非手术肺癌患者分为观察组及对照组.2组患者均给予常规抗肺癌治疗,观察组患者在上述干预基础上辅以肺康复运动训练(包括呼吸训练、咳嗽咳痰训练、呼吸体操及步行训练等).于入选时、治疗8周、16周及24周时分别采用肺功能测定[包括用力肺活量(FVC)、1秒用力呼气容积(FEV1)、FEV1/FVC％等指标]、6分钟步行试验(6MWT)、生命质量核心量表(EORTC QLQ-C30)等对2组患者进行疗效评定,同时记录、分析2组患者并发症发生情况;于治疗结束后对2组患者疾病无进展生存时间(PFS)以及总生存期(OS)进行随访.结果 观察组治疗8周、16周、24周时其FVC[分别为(2.76±0.78)L,(2.88±0.56)L及(2.94±0.65)L]、FEV1[分别为(2.22±0.65)L,(2.35±0.24)L及(2.46±0.62)L)]及6MWT[分别为(446.3±13.4)m,(450.4±12.7)m及(455.8±11.9) m)]均优于治疗前及对照组水平(P＜0.05).对照组上述时间点其FVC、FEV1及6MWT均较治疗前无明显改善(P＞0.05).观察组治疗后其QLQ-C30躯体功能、社会功能、情绪功能、疲倦、恶心呕吐、疼痛、呼吸困难、失眠、食欲、便秘以及整体生活质量评分均较对照组明显改善(P＜0.05).对照组患者肺部并发症发生率(25.6％)明显高于观察组水平(11.1％).观察组中位PFS(14.3个月)、OS(27.3个月)均较对照组(分别为13.7个月、26.1个月)有改善趋势,但组间差异无统计学意义(P＞0.05).结论 在常规抗肿瘤基础上辅以肺康复运动训练(以呼吸训练及有氧运动为主),可有效改善非手术肺癌患者生活质量,降低呼吸系统并发症发生率,促进呼吸运动功能恢复,该联合疗法值得临床进一步研究、推广.

abstractsObjective To explore the effect of pulmonary rehabilitation training on the respiratory function,motor function,life quality,survival and complications of patients with non-operative lung cancer.Methods A group of 88 patients with non-operative lung cancer was randomly divided into a training group (n=45) and a control group (n=43).Both groups were given anti-tumor therapy,while the training group was additionally provided with systematic respiratory training,including breathing pattern training,cough and expectoration training,respiratory gymnastics and walking training.Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were measured at the outset and after 8,16 and 24 weeks of the training.The 6-minute walk test (6MWT) was administered along with the QLQ-C30 assessment of the European Organization for Research and Treatment of Cancer.Complications in both groups were also recorded and analyzed.The progression-free survival (PFS) and overall survival (OS) were followed up after the treatment.Results After 8,16 and 24 weeks of the treatment,the average FVC and FEV1 volumes and the 6MWT times of the training group were significantly better than those before treatment and significantly better than the control group averages.Indeed,no significant improvement was observed in the control group's average FVC,FEV1 or 6MWT results.After 24 weeks the treatment group's average scores on the physical function,social function,emotional function,fatigue,nausea and vomiting,pain,dyspnea,insomnia,appetite,constipation,and overall quality of life sub-scales of the QLQ-C30 had all improved significantly more than in the control group.The incidence of pulmonary complications in the control group (26％) was significantly higher than that in the training group.(11％).The median PFS and OS of the training group (14.3 and 27.3 months) were not significantly better than those of the control group,however.Conclusion Respiratory exercise training and aerobic exercise training combined with the anti-tumor therapy,while not prolonging survival,can effectively improve the life quality of patients with non-operative lung cancer,reducing the incidence of complications and promoting the recovery of respiratory function.The combination is worthy of popularization in clinical practice.