沈灵姿　郭海谢　叶敏华

[關键词] 非小细胞肺癌;肺癌根治术;胸腔镜;呼吸训练器;肺功能;肺部并发症

[中图分类号] R734.2          [文献标识码] B          [文章编号] 1673-9701（2021）17-0081-04

Application of breathing exerciser after thoracoscopic radical resection of non-small cell lung cancer

SHEN Lingzi   GUO Haixie   YE Minhua

Department of Thoracic Surgery， Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University， Linhai   317000， China

[Abstract] Objective To explore the application of breathing exerciser after thoracoscopic radical resection of non-small cell lung cancer （NSCLC）. Methods From January 2018 to December 2019， a total of 92 patients who were treated by thoracoscopic radical surgery of NSCLC in the department of thoracic surgery in our hospital were selected and randomly divided into an intervention group and a control group， with 46 cases in each group. The control group was given simple breathing exercises， and the intervention group was given breathing exerciser for exercise on the basis of the control group. The two groups were given the intervention for 3 months. The changes of lung function indices and respiratory and motor functions before the surgery and 3 months after intervention were observed in both groups， and postoperative pulmonary complications were compared. Results After 3 months of intervention， the pulmonary function indices of FEV1， FVC and MVV in both groups were significantly lower than those before the surgery （P<0.05 or P<0.01）， and the rate of decrease in the intervention group after treatment was lower than that in the control group （P<0.05）; the Borg score in both groups was significantly higher than that before the surgery， and 6MWT was significantly lower than that before the surgery（P<0.05 or P<0.01）. After treatment， the magnitude of change in the intervention group was lower than that in the control group（P<0.05）; pulmonary complications occurred in 5 cases （10.87%） and 13 cases （28.26%） in the intervention group and control group respectively. The incidence rate of postoperative pulmonary complications in the intervention group was lower than that in the control group （χ2=4.421， P<0.05）. Conclusion The application of breathing exerciser after thoracoscopic radical resection of NSCLC can not only promote the recovery of patients' lung function， respiratory function and motor function， but also reduce the occurrence of postoperative pulmonary complications.

[Key words] Non-small cell lung cancer （NSCLC）; Radical resection of lung cancer; Thoracoscopy; Breathing exerciser; Lung functions; Pulmonary complications

肺癌是一种胸外科常见的恶性肿瘤，非小细胞肺癌（NSCLC）最多见，占肺癌总体发病率的80%～90%[1-2]。手术治疗是治疗NSCLC的最直接有效的方案，其中胸腔镜下肺癌根治术是首选术式，但由于肺叶的切除引起肺容量下降及手术引起创伤，引起膈肌功能紊乱，影响机体呼吸肌运动，阻碍肺通气和换气功能，严重影响心肺功能，增加肺部并发症的发生[3-4]。以往多采用简易呼吸锻炼等方法改善肺癌术后肺功能，提高运动耐力，但总体效果不甚理想[5]。呼吸训练器是为锻炼呼吸功能而研制的器械，与传统呼吸功能锻炼方法相比，具有量化明确和视觉直观等优点，已逐渐应用胸部手术围术期呼吸功能锻炼中，但用于肺癌术后国内报道较少[6-7]。本研究分析呼吸训练器在胸腔镜下NSCLC根治术后的应用，现报道如下。

1 资料与方法

1.1 一般资料

选取2018年1月至2019年12月我院胸外科住院的胸腔镜手术治疗的NSCLC根治术后患者92例。纳入标准[8]：①符合《中国肺癌临床指南》中的NSCLC的诊断标准[9]，并经细胞学或组织学证实，临床分期为IA～IIA期;②年龄18～80岁，术前未行放疗或化疗。排除标准[10]：①以往有开胸手术史或存在影响肺功能的肺部疾病;②合并恶液质或严重营养不良者;③以往存在神经精神系统障碍、文盲或无法正常交流者。采用随机数字表分为两组，每组各46例。两组性别、年龄和肿瘤分期等比较，差异无统计学意义（P>0.05），具有可比性。。……