Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial
Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial
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DOI：
10.1016/j.jss.2016.09.033
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发表时间：
2017-03-01
影响因子：
2.2
通讯作者：
Che, Guowei
中科院分区：
文献类型：
--
作者：
Lai, Yutian;Huang, Jian;Che, Guowei
背景：术前肺康复作为一种新兴的治疗方法，已得到深入研究。然而，很少有研究评估高龄与肺癌（LC）患者，特别是等待治疗性LC手术的患者的术前PR的短期密集模式之间的关系。本研究探讨了短期术前PR结合吸气肌训练（IMT）和有氧耐力训练的老年患者计划接受LC lobectomy.Methods：一项前瞻性随机对照试验，共60名年龄≥ 70岁进行。干预组（PR组）在肺叶切除术前接受1 wk系统、高强度的术前PR训练，对照组（NPR组）接受常规术前呼吸管理。结果：30例患者（PR组）完全完成术前7 d强化PR，30例患者（NPR组）作为对照组。两组在基线时具有可比性。在术前PR期间，6-MWD显著延长（增加：28.6 +/- 18.2 vs 9.4 +/- 27.0 m;组间差异：19.2 m，P = 0.029）和PEF增加（增加：26.2 +/- 22.5 vs 8.2 +/- 10.3 L/min;组间差异：18.0 L/min，P < 0.001）。LC手术后，PR组的平均术后住院时间（6.9 +/- 4.4 vs 10.7 +/- 6.4 d，P = 0.010）和总住院时间（16.0 +/- 4.5 vs 19.7 +/- 6.5 d，P = 0.012）显著缩短。在4例患者中观察到30天PPC（13.3%）PR组和11例NPR组有效率为36.7%，两组比较差异有统计学意义（P = 0.037）。对于计划在中国接受手术的老年LC患者，一个7-术前PR强化模式结合IMT和有氧耐力训练可能是一种可行的康复策略，方面的影响. (C)2016 Elsevier Inc. All rights reserved.
Background: As a newly developed treatment, preoperative pulmonary rehabilitation (PR) has been studied in depth. However, few studies have assessed the relationship between advanced age and a shorter term intensive pattern of preoperative PR in patients with lung cancer (LC) and especially those patients waiting for therapeutic LC surgeries. This study investigated short-term preoperative PR combined with inspiratory muscle training (IMT) and aerobic endurance training in elderly patients scheduled to undergo LC lobectomy.Methods: A prospective randomized controlled trial with a total of 60 subjects aged >= 70 y was conducted. The intervention group (PR group) was treated for 1 wk with systematic and highly intensive preoperative PR training before lobectomy, and the control group (NPR group) was treated with conventional preoperative respiratory management. We analyzed the 6-min walking distance (6-MWD), the peak expiratory flow (PEF), and quality-of-life scores before and after the rehabilitation regimen as well as the incidence of postoperative pulmonary complications (PPCs).Results: In total, 30 patients (PR group) completely executed the 7-d intensive preoperative PR, and 30 patients (NPR group) served as the control group. The two groups were comparable at baseline. During the preoperative PR, a significantly longer 6-MWD (increase: 28.6 +/- 18.2 versus 9.4 +/- 27.0 m; between-groups difference: 19.2 m, P = 0.029) and an increased PEF (increase: 26.2 +/- 22.5 versus 8.2 +/- 10.3 L/min; between-groups difference: 18.0 L/min, P < 0.001) were noted in the PR group compared with the NPR group. After LC surgery, the mean postoperative length of stay (6.9 +/- 4.4 versus 10.7 +/- 6.4 d, P = 0.010) and total hospital stay (16.0 +/- 4.5 versus 19.7 +/- 6.5 d, P = 0.012) were significantly reduced in the PR group. Thirty-day PPCs were noted in four (13.3%) patients in the PR group and 11 (36.7%) patients in the NPR group, with a significant difference between the two groups (P = 0.037).Conclusions: For elderly LC patients scheduled to undergo surgery in China, a 7-d intensive pattern of preoperative PR combined with IMT and aerobic endurance training may be a feasible rehabilitation strategy with positive physical and psychological effects. (C) 2016 Elsevier Inc. All rights reserved.