The Effect of Active Circulatory Breathing Training in Patients undergoing Lung Cancer Surgery under 5A Mode
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摘要:
目的 分析基于5A [询问 （Ask）、评估 （Asses）、建议 （Advice）、帮助 （Assist）、安排随访 （Arrange）] 模式下主动循环呼吸技术训练在胸腔镜肺癌手术患者中的应用效果。 方法 选取安徽省胸科医院2023年5月至2023年8月收治的100例拟行胸腔镜手术治疗的肺癌患者，使用简单随机法分别纳入观察组（n = 50）、对照组（n = 50）。2组均接受常规围术期综合护理，观察组加用基于5A模式的主动循环呼吸技术训练。对比2组术后恢复情况、排痰量、并发症差异，记录2组术前、术后3个月心肺功能和呼吸困难度、运动功能变化。 结果 观察组胸管拔除时间、胸腔引流量及术后住院时间均较对照组更低（P < 0.05）。观察组术后第1 天、第2 天、第3 天排痰量均较对照组更低（P < 0.05）。观察组术后并发症发生率较对照组更低（P < 0.05）。2组术后3个月左室射血分数（left ventricular ejection fraction，LVEF）均较术前1 d升高，左室舒张末期内径（left ventricular end diastolic diameter，LVEDD）均下降，且第1秒用力呼气容积（forced expiratory volume for 1 second，FEV1）、用力肺活量（Forced vital capacity，FVC）、最大呼气流量（peak expiratory flow，PEF）均较术前1 d下降；观察组术后3个月LVEF较对照组更高、LVEDD较对照组更低，且FEV1、FVC、PEF均较对照组更高（P < 0.05）。2组术后3个月呼吸困难量表（multiple myeloma research consortium，mMRC）评分均较术前1 d升高、6 min步行距离（6-min walking distance，6MWT）均下降；观察组术后3个月mMRC评分较对照组更低、6MWT较对照组更高（P < 0.05）。 结论 基于5A模式下主动循环呼吸技术训练能够促进肺癌患者胸腔镜手术后早期恢复和术后排痰，也有助于预防术后并发症、促进术后运动功能改善，并有效降低术后呼吸困难度。 Abstract:Objective To analyze the application effect of active circulatory breathing training in patients undergoing thoracoscopic lung cancer surgery based on 5A （Ask, Asses, Advice, Assist, Arrange） mode. Methods 100 patients with lung cancer, treated by thoracoscopic surgery in Anhui Provincial Chest Hospital from May 2023 to August 2023, were randomly divided into observation group （n = 50） and control group （n = 50）. Both groups received routine perioperative comprehensive nursing care, while the observation group was additionally trained with active circulatory breathing technique based on 5A mode. The differences of postoperative recovery, sputum output and complications between the two groups were compared, and the changes of cardiopulmonary function, dyspnea and motor function before and 3 months after operation were recorded. Results The time of chest tube removal, thoracic drainage and postoperative hospital stay in the observation group were shorter than those in the control group （P < 0.05）. The sputum output of the observation group was lower than that of the control group on the 1st, 2nd and 3rd day after operation （P < 0.05）. The incidence of postoperative complications in the observation group was lower than that in the control group （P < 0.05）. 3 months after operation, LVEF （left ventricular ejection fraction） increased and LVEDD （left ventricular end diastolic diameter） decreased in both groups, and FEV1（forced expiratory volume for 1 second）, FVC （forced vital capacity） and PEF （peak expiratory flow） decreased compared with that in the first day before operation. Three months after operation, LVEF was higher, LVEDD was lower and FEV1, FVC and PEF were higher in the observation group than in the control group （P < 0.05）. 3 months after operation, the mMRC （multiple myeloma research consortium） scores of both groups were higher than those of preoperative one day, and the 6MWT （6-min walking distance） was lower. mMRC score was lower and 6MWT was higher in the observation group than in the control group 3 months after operation （P < 0.05）. Conclusion The training of active circulatory breathing technology based on 5A mode can promote the early recovery and postoperative sputum production in lung cancer patients undergoing thoracoscopic surgery. It also helps to prevent postoperative complications, improve postoperative motor function, and effectively reduce postoperative breathing difficulties. -
Key words:
- 5A mode /
- Active circulatory breathing technology /
- Thoracoscope /
- Lung cancer
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表 1 2组肺癌患者一般材料比较[（$ \bar x \pm s $）/n（%），n = 50]
Table 1. Comparison of clinical data between two groups of lung cancer patients [（$ \bar x \pm s $）/n（%），n = 50]
组别 年龄（岁） BMI（kg/m2） 性别[n（%）] 临床分期[n（%）] 病理分型[n（%）] 男 女 T1期 T2期 腺癌 其他 观察组 55.70±7.12 23.83±3.12 20（40.00） 30（60.00） 39（78.00） 11（22.00） 41（82.00） 9（18.00） 对照组 53.84±7.46 24.07±3.12 21（42.00） 29（58.00） 37（74.00） 13（26.00） 42（84.00） 8（16.00） t/χ2 1.275 0.385 0.041 0.219 0.071 P 0.205 0.701 0.839 0.640 0.790 注：BMI：体质量指数（Body mass index）。 
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表 2 2组术后恢复情况比较（$ \bar x \pm s $，n = 50）
Table 2. Comparison of postoperative recovery between two groups（$ \bar x \pm s $，n = 50）
组别 肛门排气时间（d） 胸管拔除时间（d） 胸腔引流量（mL） 术后住院时间（d） 观察组 1.35±0.26 3.21±0.34 151.49±18.42 6.08±1.59 对照组 1.39±0.25 3.47±0.51 162.35±20.26 6.83±1.75 t 0.784 2.999 2.804 2.243 P 0.435 0.003* 0.006* 0.027* *P < 0.05。
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表 3 2组术后排痰量比较（$ \bar x \pm s $，n = 50）
Table 3. Comparison of postoperative sputum volume between two groups（$ \bar x \pm s $，n = 50）
组别 术后1 d（mL） 术后2 d（mL） 术后3 d（mL） 观察组 4.37±0.52 9.91±1.07 12.83±2.15 对照组 4.11±0.39 9.48±0.79 11.75±1.69 t 2.828 2.286 2.793 P 0.006* 0.024* 0.006* *P < 0.05。
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表 4 2组术后并发症比较（[n（%）]，n = 50）
Table 4. Comparison of postoperative complications between two groups（[n （%）]，n = 50）
组别 肺部感染 肺不张 低氧血症 合计 观察组 1（2.00） 1（2.00） 0 2（4.00） 对照组 4（8.00） 1（2.00） 3（6.00） 8（16.00） χ2 − − − 4.000 P − − − 0.046* *P < 0.05。
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表 5 2组术前、术后心肺功能变化比较（$ \bar x \pm s $，n = 50）（1）
Table 5. Comparison of changes in cardiopulmonary function between two groups before and after surgery（$ \bar x \pm s $，n = 50）（1）
组别 LVEF（%） LVEDD（mm） 术前1 d 术后3个月 术前1 d 术后3个月 观察组 41.73±4.08 56.71±6.05* 61.08±5.95 51.08±2.99* 对照组 42.05±4.13 53.49±5.83* 61.24±6.13 52.54±3.18* t 0.390 2.710 0.132 2.365 P 0.698 0.008# 0.895 0.020# 与术前1 d比较，*P < 0.05；对照组与观察组比较，#P < 0.05。
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表 5 2组术前、术后心肺功能变化比较（$ \bar x \pm s $，n = 50）（2）
Table 5. Comparison of changes in cardiopulmonary function between two groups before and after surgery（$ \bar x \pm s $，n = 50）（2）
组别 FEV1（L） FVC（L） PEF（L/min） 术前1 d 术后3个月 术前1 d 术后3个月 术前1 d 术后3个月 观察组 2.56±0.29 2.27±0.31* 2.18±0.25 2.05±0.21* 4.75±0.83 4.21±0.65* 对照组 2.61±0.33 2.14±0.22* 2.22±0.23 1.92±0.19* 4.69±0.74 3.88±0.59* t 0.805 2.418 0.833 3.246 0.382 2.658 P 0.423 0.017# 0.407 0.002# 0.704 0.009# 与术前1 d比较，*P < 0.05；对照组与观察组比较，#P < 0.05。
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表 6 2组术前、术后呼吸困难度和运动功能变化比较（$ \bar x \pm s $）
Table 6. Comparison of changes in respiratory distress and motor function between two groups before and after surgery（$ \bar x \pm s $）
组别 n mMRC评分（分） 6MWT（m） 术前1 d 术后3个月 术前1 d 术后3个月 观察组 50 0.49±0.11 0.78±0.14* 181.75±26.93 135.52±21.84* 对照组 50 0.52±0.09 0.89±0.19* 180.95±27.41 122.60±18.75* t -- 1.493 3.296 0.147 3.174 P -- 0.139 0.001# 0.883 0.002# #P < 0.05；与术前1 d比较，*P < 0.05。
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