Thoracoscopic Lobectomy Effect Of Preoperative Respiratory Muscle Training On Pulmonary Function And Pulmonary Inflammation After Surgery

Objective:To investigate the effects of respiratory muscle training before thoracoscopic pulmonary surgery on postoperative pulmonary function,tracheal intubation time,chest catheter indwelling time,hospitalization time and the occurrence of pulmonary inflammation.Provide theoretical basis for preoperative reasonable intervention and postoperative accelerated recovery.Method:According to the established inclusion,exclusion criteria were selected from February 2017 to January 2018 at the Lanzhou General Hospital of the Chinese people’s Liberation Army for lung cancer who underwent thoracoscopic lobectomy and lymphadenectomy.A total of 40 non-infected patients,including 26 men and 14women,underwent.All the patients were divided into experimental group and control group according to random number table,experimental group（n=19）and control group（n=21）.There was no significant difference in age,sex,operation method and histological type between the two groups（P>0.05）.All the patients had no dysfunction of heart,brain,liver and kidney.All patients should quit smoking for at least one week before operation,and teach them to take deep breathing and effective cough and sputum training.All patients should be treated with atomization before and after operation.Immediately after operation,they were transferred to the chest surgery intensive care unit,ventilator assisted breathing,the responsible nurses checked the patient’s condition every 15 minutes,pulled out the tracheal intubation according to the extubation indication strictly,and gave the second generation antibiotic to prevent the postoperative infection.The nursing and treatment measures before and after operation in the experimental group were exactly the same as those in the control group.The intervention measures were respiratory function training lasting 5 days before operation.The training methods include lip reduction,abdominal breathing training and breathing training.In the study,FEV1%pred and FEV1/FVC were selected to reflect the alveolar ventilation ability,DLCOpred and DLCO/VA to reflect the mass ventilation function of the patients.PaO_2,PaO₂/FiO_2,A-aDO_2,A-aDO₂/PaO₂were used to reflect the ability of alveolar and blood oxygen exchange.In order to reflect the postoperative pulmonary inflammation,WBC,CRP,PCT,IL-6 were used as an inflammatory index.Blood gas analysis,CRP,PCT,IL-6 and blood routine test were performed at 4 time points:T₀,T₁,T₂ and T₃,respectively.All subjects were examined for pulmonary function at admission time（T₀）and 5 days postoperatively（T₃）.Postoperative tracheal intubation,chest tube indwelling and length of stay were carefully recorded.Result:There was no significant difference in WBC,CRP,PCT and IL-6 between the two groups on admission（T₀）（P>0.05）,excluding the influence of individual differences before operation on the results of the study.On the first day after operation（T₁）,the white blood cell count was significantly increased,and the white blood cell count decreased gradually on the 3rd day（T₂）and the 5th day（T₃）after operation.There was no significant difference in the white blood cell count between the experimental group and the control group at the same time（P>0.05）.The CRP count of the two groups increased gradually and then decreased slowly.The CRP count in the experimental group was lower than that in the control group on the first day after operation（T₁）（P<0.05）.There was no significant difference in CRP count between the experimental group and the control group on the 3rd day（T₂）and the 5th day（T₃）（P>0.05）.The first days after operation（T₁）,third days（T₂）PCT increased significantly and then decreased gradually.There was no significant difference between the two groups（P>0.05）.On the 5th day after operation（T₃）,the PCT count of the two groups continued to decrease,and the decrease of PCT in the experimental group was larger than that in the control group（P<0.05）.On the first day after operation（T₁）,the IL-6 values of the two groups were significantly higher than those of the preoperative ones,but on the 3rd day（T₂）and the 5th day（T₃）after operation,the IL-6 values of the two groups decreased gradually,but there was no significant difference between the two groups at the same time point（P>0.05）.On admission（T₀）,there was no significant difference between the two groups in PaO₂,PaO₂/FiO₂,A-aDO₂ andA-aDO₂/PaO₂（P>0.05）.Onthefirstdayafter operation（T₁）,the PaO₂ values of the two groups were significantly lower than those before operation,and on the 3rd day（T₂）and the 5th day（T₃）after operation,the PaO₂values of the two groups increased gradually.At the same time,there was no significant difference in PaO₂ between the experimental group and the control group（P>0.05）.There was no significant difference in PaO₂/FiO₂ between the two groups after the first day of operation（T₁）（P>0.05）,and the two groups increased slowly in the third day after operation（T₂）.PaO₂/FiO₂ recovered gradually in the two groups on the 5th day after operation（T₃）.The value of PaO₂/FiO₂ in the experimental group was higher than that in the control group（P<0.05）.On the first day after operation（T₁）,the A-aDO₂ value of the two groups was significantly higher than that of the control group,and the A-aDO₂ decreased gradually on the 3rd day（T₂）and the 5th day（T₃）after operation.There was no significant difference in A-aDO₂ between the experimental group and the control group at the same time point（P>0.05）.A-aDO₂/PaO₂ increased gradually in both groups on the first day after operation（T₁）.The A-aDO₂/PaO₂ in the experimental group was lower than that in the control group（P<0.05）.The A-aDO₂/PaO₂ decreased gradually on the 3rd day after operation（T₂）,but there was no significant difference between the experimental group and the control group（P>0.05）.The A-aDO₂/PaO₂ of the experimental group was lower than that of the control group on the 5th day after operation（T₃）,and the difference was statistically significant（P<0.05）.There was no significant difference in FEV1%pred,FEV1/FVC,DLCO%pred and DLCO/VA between the experimental group and the control group on admission（P>0.05）.On the 5th day after operation（T₃）,the pulmonary function test showed that there was no significant difference in FEV1%pred,FEV1/FVC and DLCO%pred in the experimental group compared with the control group（P>0.05）.Postoperative DLCO/VA in experimental group was higher than that in control group（P<0.05）.According to statistics,tracheal intubation time was 102.37±28.55 min in the experimental group and 114.05±42.77 min in the control group.There was no significant difference between the two groups（P>0.05）.In the experimental group,the length of postoperative thoracic drainage tube was 3.11±0.94 days,and the postoperative hospitalization time was 6.53±1.47 days.In the control group,the length of the chest tube was 5.14±2.39 days,and the postoperative hospital stay was8.29±3.09 days.The length of chest tube and hospital stay in the experimental group was shorter than that in the control group（P<0.05）.Conclusion:1.Preoperative respiratory muscle training can reduce the production of some inflammatory factors after operation,have a positive effect on reducing pulmonary inflammatory reaction,and promote postoperative rehabilitation.2.Preoperative respiratory muscle training could increase the gas exchange between alveoli and capillaries,and improve the pulmonary ventilation ability after operation,but the effect on pulmonary ventilation ability was not clear.3.Preoperative respiratory muscle training can reduce the time of chest drainage tube retention and postoperative hospitalization,accelerate the postoperative recovery of patients.