Application Of Perioperative Comprehensive Lung Rehabilitation Intervention In Elderly Patients With Lung Cancer Radical Operation

Purpose:To explore the safety and effectiveness of perioperative pulmonary rehabilitat ion intervention program for elderly patients with lung cancer undergoing thoracoscopi c radical resection.The time of postoperative tube,postoperative hospital stay,postope rative complications,lung function and exercise endurance were observed,so as to pro vide the basis for the clinical practice of perioperative pulmonary rehabilitation interve ntion program.Methods:The elderly patients（over 60 years old）scheduled for thoracoscopic radical resection of lung cancer in the Department of thoracic surgery of Subei people’s Hospital of Jiangsu Province from January 2020 to December 2020 were prospectively collected.After recording the relevant clinical data on the day of admission,the patients were randomly divided into control group and lung rehabilitation group.The two groups were given routine nursing and health education 5 days before operation,while the lung rehabilitation group was given progressive comprehensive lung rehabilitation intervention,mainly including aerobic exercise and chest physical therapy.The lung function and exercise endurance of the two groups were tested 1 day before operation and on the day of discharge,the time of chest closed drainage tube and hospitalization、postoperative complications were recorded in time.SPSS 20.0 software was used to compare and analyze the differences between the two groups in terms of postoperative catheter time,postoperative hospital stay,postoperative complications,and the intra group and inter group differences in lung function and exercise tolerance at different time points.Result:A total of 64 lung cancer patients met the inclusion criteria,and 58 patients completed the study,including 29 in the lung rehabilitation group and 29 in the control group.There was no significant difference in baseline data between the two groups.Results of catheter time,postoperative hospital stay and complications:compared with the control group,patients in the pulmonary rehabilitation group were able to extubate earlier（4.21±1.32d vs 5.07±1.31d,P=0.015）and return to hospital as soon as possible（5.31±1.23d vs 7.48±1.70d,P=0.000）.The incidence of postoperative pulmonary complications（PPC）in pulmonary rehabilitation group was significantly lower than that in control group[17.2%（5/29）vs 44.8%（13/29）,P=0.023],in which the incidence of pulmonary infection and atelectasis was significantly lower[10.3%（3/29）vs 34.5%（10/29）,P=0.028;6.9%（2/29）vs 31.3%（9/29）,P=0.028],There was no significant difference in the incidence of pneumothorax,subcutaneous emphysema,respiratory failure[3.4%（1/29）vs 10.3%（3/29）,P=0.611;10.3%（3/29）vs 17.2%（5/29）,P=0.706;3.4%（1/29）vs 10.3%（3/29）,P=0.611],nor was the incidence of arrhythmia[3.4%（1/29）vs 6.9%（2/29）,P=1.000].No empyema or bronchopleural fistula occurred in the two groups,and 1 case of pulmonary embolism occurred in the control group.The results of lung function and sports endurance were as follows:After 5 days of active preoperative rehabilitation,the forced expiratory volume in the first second（FEV1）,forced vital capacity（FVC）,peak expiratory flow（PEF）and maximum expira tory pressure（MEP）of the pulmonary rehabilitation group were[（2.53±0.18）L,（2.85±0.58）L,（439.48±49.20）L/min,（67.41±7.16）cm H₂O],which was significantly higher than that of the control group[（2.38±0.13）L,（2.51±0.56）L,（391.31±61.40）L/min,（64.10±10.40）cm H₂O]（P=0.001,P=0.027,P=0.002,P=0.034）.The 6-minute walking distance（6-MWD）of the l ung rehabilitation group was also better than that of the control group[（426.00±51.36）m vs（390.14±39.07）m,P=0.004].After surgical trauma,the lung function and exercise endurance of the two groups were significantly decreased in different degree s,but the indexes of the lung rehabilitation group who could adhere to the postoperati ve rehabilitation plan on the day of discharge were better than those of the control gr oup,which were FEV1[（1.39±0.14）L vs（1.17±0.14）L,P=0.000]、FVC[（2.17±0.34）L vs（1.89±0.29）L,P=0.002]、PEF[（227.69±40.96）L/min vs（201.28±42.15）L/min,P=0.019]、MEP[（54.55±8.46）cm H₂O vs（46.67±6.57）cm H₂O,P=0.000]、6-MWD[（315.52±47.39）m vs（260.79±44.41）m,P=0.000]。Conclusion:Perioperative comprehensive lung rehabilitation intervention can significantly reduce the tube time,postoperative hospital stay and PPC of elderly patients undergoing thoracoscopic radical resection of lung cancer;it can significantly improve the preoperative lung function and exercise endurance of elderly patients with lung cancer,and accelerate the postoperative rehabilitation and get out of hospital as soon as possible.