术前短期综合肺康复训练对肺癌合并轻中度慢性阻塞性肺病患者的影响：一项前瞻性随机对照试验

BACKGROUND AND OBJECTIVE: Pulmonary rehabilitation (PR) is proposed as an effective strategy to decrease surgical morbidity. However, appropriate rehabilitation plan, initiation time, and optimal duration of PR remain unclear. Lung cancer patients with chronic obstructive pulmonary disease (COPD) are considered high-risk population for postoperative pulmonary complications (PPCs) because of poor lung fitness and cardiopulmonary endurance. This study aims to assess the impact of a one-week, systematic and highly-intensive rehabilitation on surgical lung cancer patients with mild to moderate COPD. METHODS: A randomized controlled trial with 48 subjects was conducted (24 patients each for the intervention and groups). The intervention group received seven days of systematic, integrated and highly-intensive PR before surgical treatment, including: pharmacotherapy with atomizing terbutaline, pulmicort and infusion of ambroxol; and physical rehabilitation with respiratory training and endurance training. The control group underwent standard preoperative care. RESULTS: For the intervention group, the postoperative length of stay was shorter [(6.17±2.91) d vs (8.08±2.21) d; P=0.013]; likewise for the duration of antibiotics use [(3.61±2.53) d vs (5.36±3.12) d; P=0.032]. No significant difference was found between the groups in total in-hospital cost [(46, 455.6±5, 080.9) ￥ vs (45, 536.0±4, 195.8) ￥, P=0.498], medicine cost [(7, 760.3±2, 366.0) vs (6, 993.0±2, 022.5), P=0.223], and material cost [(21, 155.5±10, 512.1) ￥ vs (21, 488.8±3, 470.6) ￥, P=0.883]. In the intervention group, peak expiratory flow [(268.40±123.94) L/min vs (343.71±123.92) L/min; P < 0.001], 6-min walk distance (6-MWD) [(595.42±106.74) m vs (620.90±99.27) m; P=0.004], and energy consumption [(59.93±10.61) kcal vs (61.03±10.47) kcal; P=0.004] were statistically different after the seven-day exercise, compared with those on the first day. Finally, for the intervention group the incidence of PPCs (8.3%, 2/24 vs 20.8%, 5/24, 20.8%; P=0.416) were lower. CONCLUSION: The systematic and highly-intensive pulmonary rehabilitation combining abdominal respiration training, respiratory exercise with incentive spirometry, and aerobic exercise could improve the cardiorespiratory endurance of lung cancer patients with mild to moderate COPD. The proposed program may be a practicable preoperative strategy.