Effect of preoperative pulmonary rehabilitation on postoperative pneumonia in patients with lung cancer

doi:10.3877/cma.j.issn.2095-8773.2017.03.07

Abstract

Abstract:

Objective

The purpose of this study was to investigate whether preoperative pulmonary rehabilitation could prevent postoperative pneumonia.

Methods

Retrospective research was conducted on 792 lung cancer patients who underwent lobectomy at the West China Hospital of Sichuan University from January 2014 to July 2015. The patients were divided into two group including 148 patients with pulmonary rehabilitation and 644 patients without pulmonary rehabilitation; the incidence of postoperative pneumonia and the related clinical data were compared between the two groups.

Results

The incidence of postoperative pneumonia in the pulmonary rehabilitation group was significantly lower than that in the non-pulmonary rehabilitation group (8.1% vs 15.8%, P=0.013); The antibiotic use time, chest tube duration, postoperative hospital stay and drug costs in pulmonary rehabilitation group were statistically lower than non-pulmonary rehabilitation group [(4.1±2.1)d vs (4.9±2.5)d, P<0.001; (3.8±2.3)d vs (4.3±2.8)d, P=0.023; (5.9±3.2)d vs (7.2±4.6)d, P<0.001; (7 354.3±2 743.2)￥ vs (8 265.2±3 126.5)￥, P=0.001]. The risk factors of postoperative pneumonia include age>70 years (OR=6.998, 95% CI: 4.236-11.561, P<0.001) , smoking history(OR=2.286, 95% CI: 1.145-4.456, P=0.019), thoracotomy(OR=1.990, 95% CI: 1.247-4.3.177, P=0.004)and duration of surgery>180 min(OR=7.228, 95% CI: 2.657-19.666, P<0.001).

Conclusions

Preoperative pulmonary rehabilitation can reduce the incidence of postoperative pneumonia(OR=0.377, 95% CI: 0.188-0.756, P=0.006)and enhance recovery after surgery in patients with lung cancer.

Key words: Pulmonary rehabilitation, Pneumonia, Lung neoplasms, Enhanced recovery after surgery

Kun Zhou, Jianhua Su, Yutian Lai, Pengfei Li, Yanming Wu, Guowei Che. Effect of preoperative pulmonary rehabilitation on postoperative pneumonia in patients with lung cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2017, 04(03): 164-170.

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References 25

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临床特征		肺康复训练组(n＝148)	常规治疗组(n＝644)	检验值	P值
平均年龄(岁，±s)		59.4±10.0	59.2±10.1	t＝0.230	0.818
性别[n(%)]		?	?	χ²＝1.980	0.159
?	男性	91(61.5)	352(55.1)	?	?
?	女性	57(38.5)	292(44.9)	?	?
肺功能指标(±s)		?	?	?	?
?	FEV₁(L)	2.4±0.4	2.5±0.4	t＝1.647	0.100
?	ppoFEV₁%	67.9±17.3	69.3±18.1	t＝0.852	0.394
?	Dlco(ml·min^-1·mmHg^-1)	21.9±4.9	22.6±5.1	t＝1.615	0.107
?	ppoDlco%	71.3±23.9	72.0±23.5	t＝0.327	0.744
吸烟史[n(%)]		?	?	χ²＝1.095	0.295
?	既往吸烟	66(44.6)	257(39.9)	?	?
?	不吸烟	82(55.4)	387(60.1)	?	?
合并症[n(%)]		?	?	?	?
?	糖尿病	13(8.8)	46(7.1)	χ²＝0.470	0.493
?	高血压	22(14.9)	88(13.7)	χ²＝0.028	0.703
?	COPD	23(15.6)	74(11.5)	χ²＝1.902	0.168
手术方式[n(%)]		?	?	χ²＝0.591	0.442
?	开胸	47(31.8)	184(28.6)	?	?
?	VATS	101(68.2)	460(71.4)	?	?
临床分期[n(%)]		?	?	χ²＝0.966	0.809
?	Ⅰ期	76(51.4)	300(46.6)	?	?
?	Ⅱ期	51(34.5)	269(41.8)	?	?
?	Ⅲ期	19(12.5)	68(10.6)	?	?
?	Ⅳ期	2(1.4)	7(1.1)	?	?

临床特征		肺康复训练组(n＝148)	常规治疗组(n＝644)	检验值	P值
平均年龄(岁，±s)		59.4±10.0	59.2±10.1	t＝0.230	0.818
性别[n(%)]		?	?	χ²＝1.980	0.159
?	男性	91(61.5)	352(55.1)	?	?
?	女性	57(38.5)	292(44.9)	?	?
肺功能指标(±s)		?	?	?	?
?	FEV₁(L)	2.4±0.4	2.5±0.4	t＝1.647	0.100
?	ppoFEV₁%	67.9±17.3	69.3±18.1	t＝0.852	0.394
?	Dlco(ml·min^-1·mmHg^-1)	21.9±4.9	22.6±5.1	t＝1.615	0.107
?	ppoDlco%	71.3±23.9	72.0±23.5	t＝0.327	0.744
吸烟史[n(%)]		?	?	χ²＝1.095	0.295
?	既往吸烟	66(44.6)	257(39.9)	?	?
?	不吸烟	82(55.4)	387(60.1)	?	?
合并症[n(%)]		?	?	?	?
?	糖尿病	13(8.8)	46(7.1)	χ²＝0.470	0.493
?	高血压	22(14.9)	88(13.7)	χ²＝0.028	0.703
?	COPD	23(15.6)	74(11.5)	χ²＝1.902	0.168
手术方式[n(%)]		?	?	χ²＝0.591	0.442
?	开胸	47(31.8)	184(28.6)	?	?
?	VATS	101(68.2)	460(71.4)	?	?
临床分期[n(%)]		?	?	χ²＝0.966	0.809
?	Ⅰ期	76(51.4)	300(46.6)	?	?
?	Ⅱ期	51(34.5)	269(41.8)	?	?
?	Ⅲ期	19(12.5)	68(10.6)	?	?
?	Ⅳ期	2(1.4)	7(1.1)	?	?

临床特征		肺康复训练组(n＝148)	常规治疗组(n＝644)	检验值	P值
术后肺炎[n(%)]		?	?	χ²＝5.836	0.016
?	有	12(8.1)	102(15.8)	?	?
?	无	136(91.9)	542(84.2)	?	?
手术时间(min，±s)		115.7±34.5	120.9±38.9	t＝1.493	0.136
术中失血量(ml，±s)		94.5±43.6	90.3±42.2	t＝1.085	0.278
抗生素使用时间(d，±s)		4.1±2.1	4.9±2.5	t＝3.611	<0.001
胸引流管留置时间(d，±s)		3.8±2.3	4.3±2.8	t＝2.021	0.023
术后住院日(d，±s)		5.9±3.2	7.2±4.6	t＝3.261	<0.001
住院药费(元，±s)		7 354.3±2 743.2	8 265.2±3 126.5	t＝3.267	0.001
住院总费用(元，±s)		45 565.4±7 561.3	47 201.4±9 760.4	t＝1.911	0.056

临床特征		肺康复训练组(n＝148)	常规治疗组(n＝644)	检验值	P值
术后肺炎[n(%)]		?	?	χ²＝5.836	0.016
?	有	12(8.1)	102(15.8)	?	?
?	无	136(91.9)	542(84.2)	?	?
手术时间(min，±s)		115.7±34.5	120.9±38.9	t＝1.493	0.136
术中失血量(ml，±s)		94.5±43.6	90.3±42.2	t＝1.085	0.278
抗生素使用时间(d，±s)		4.1±2.1	4.9±2.5	t＝3.611	<0.001
胸引流管留置时间(d，±s)		3.8±2.3	4.3±2.8	t＝2.021	0.023
术后住院日(d，±s)		5.9±3.2	7.2±4.6	t＝3.261	<0.001
住院药费(元，±s)		7 354.3±2 743.2	8 265.2±3 126.5	t＝3.267	0.001
住院总费用(元，±s)		45 565.4±7 561.3	47 201.4±9 760.4	t＝1.911	0.056

临床特征		术后肺炎组(114例)	无术后肺炎组(678例)	χ²值	P值
年龄		?	?	67.581	<0.001
?	≤70岁	71(62.3)	613(90.4)	?	?
?	>70岁	43(37.7)	65(9.6)	?	?
性别		?	?	11.760	0.001
?	男性	81(71.1)	365(53.8)	?	?
?	女性	33(28.9)	313(46.2)	?	?
BMI		?	?	0.146	0.702
?	<25 kg/m²	93(81.6)	563(83.0)	?	?
?	≥25 kg/m²	21(18.4)	115(17.0)	?	?
吸烟史		?	?	19.627	0.000
?	有	68(59.6)	255(37.6)	?	?
?	无	46(40.4)	423(62.4)	?	?
糖尿病		?	?	6.294	0.012
?	有	15(13.2)	44(6.5)	?	?
?	无	99(86.8)	634(93.5)	?	?
高血压		?	?	0.742	0.389
?	有	18(15.8)	87(12.8)	?	?
?	无	96(84.2)	591(87.2)	?	?
COPD		?	?	6.330	0.012
?	有	22(19.5)	75(11.1)	?	?
?	无	92(80.7)	603(88.9)	?	?
手术方式		?	?	10.791	0.001
?	开胸	48(42.1)	183(27.0)	?	?
?	VATS	66(57.9)	495(73.0)	?	?
FEV₁%		?	?	4.058	0.044
?	<70%	44(38.6)	198(29.2)	?	?
?	≥70%	70(61.4)	480(70.8)	?	?
手术时间		?	?	17.678	0.000
?	>180 min	10(8.8)	12(1.8)	?	?
?	≤180 min	104(91.2)	666(98.2)	?	?
临床分期		?	?	7.807	0.050
?	Ⅰ	45(39.5)	331(48.8)	?	?
?	Ⅱ	51(44.7)	269(39.7)	?	?
?	Ⅳ	0(0.0)	9(1.3)	?	?

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