Clinical Study Of Lung Volume Reduction Surgery Under The Concept Of Accelerated Rehabilitation Surgery

Objective:to apply the concept of enhanced recovery after surgery(ERAS)to lung volume reduction surgery(LVRS),to explore the postoperative treatment effect of patients with LVRS under ERAS mode,and to further optimize the perioperative process of ERAS,so as to provide some reference for the establishment of standardization and standardization of ERAS.Methods:from September 2018 to January 2021,34 male patients underwent single port thoracoscopic unilateral LVRS in the Department of thoracic surgery of the First Affiliated Hospital of Kunming Medical University.After admission,they were randomly divided into accelerated rehabilitation surgery group and control group.There were 16 cases in the accelerated rehabilitation surgery group and 18 cases in the control group.Blood routine test and infection related protein test were performed before and 1 day after operation to evaluate the changes of WBC,Neu%and CRP.Pulmonary function and resting arterial blood gas test were performed before and 1 month after operation to evaluate the changes of FEV1,FVC,RV,PaO2 and PaCO2.The 6MWT distance of the two groups before and 1 month after operation was recorded,and the mMRC and SGRQ questionnaires were conducted at this time point,and BODE index was calculated.Two groups of patients in postoperative 6h,12h,24h,48h and 36h pain digital score.The drainage volume of pleural fluid in 24 hours was recorded by nurses every morning,and the drainage volume of pleural fluid in 1,2 and 3 days after operation was compared between the two groups.The operation time,postoperative ambulation time,chest tube indwelling time,postoperative hospital stay and hospitalization expenses of the two groups were recorded on the day of discharge.Results:1.Comparison of general data:there were no significant differences in age(p=0.240),BMI(p=0.853),smoking index(p=0.903),basic diseases(p=0.732),ASA score(p=0.754)and lung volume reduction site(p=0.786)between the two groups.2.Comparison of inflammatory indexes:compared with the control group,there were no significant differences in WBC,Neu%and CRP before and on the first day after operation in the accelerated rehabilitation surgery group;compared with the first day after operation,there were significant differences in WBC,Neu%and CRP between the two groups(p<0.05),among which the difference in CRP was more significant(p<0.01).3.Comparison of pulmonary function and quality of life:there were no significant differences in FEV1,FVC,RV,PaO2,PaCO2,6MWD,mMRC,BODE and SGRQ between the two groups before and 1 month after operation.There were significant differences in FEV1(2.86±0.63 vs.3.16±0.54),PaO2(64.28±12.07 vs.69.28 ±12.25),6MWD(331.70±54.65 vs.393.00±56.97),mMRC(2.50±0.53 vs.2.30± 0.48),BODE(4.90±1.10 vs.3.80±1.14)and SGRQ(52.40 ± 8.73 vs.45.80±7.47)before and 1 month after operation between the two groups(p<0.05)There were significant differences in PaO2(65.25±7.45 vs 69.58±6.33),6MWD(324.91 ±74.57 vs 384.64±78.27),BODE(5.27±0.91 vs 4.27±0.65)and SGRQ(52.27 ±9.40 vs 46.82±8.57)in the control group(p<0.05).4.Comparison of postoperative hospitalization indicators:the accelerated rehabilitation surgery group was compared with the control group ①There were significant differences in pain scores at 6h(4.91±1.52 vs.5.63±0.52,p=0.001),24h(2.91 ± 0.94 vs.3.36±0.6 7,p=0.043),48h(2.09 ± 0.54 vs.2.55±0.82,p=0.047)and 36h(1.73±0.79 vs.2.36±1.29,p=0.025),and the difference at 6h was more significant(p<0.01).②There were significant differences in operation time(1.58±0.16 vs 2.05±0.37,p=0.015),postoperative ambulation time(18.52±3.24 vs 24.41±4.48,p=0.021),chest tube indwelling time(3.28±0.90 vs 5.23±2.24,p=0.045),postoperative hospital stay(5.18±1.17 vs 7.82 ± 2.18,p=0.025).③There were significant differences in drainage volume of pleural effusion on 1d(193.07±101.22 vs.386.36±216.99,p=0.031),2d(238.13±136.61 vs.400.38±227.29,p=0.009)and 3d(128.50± 71.49vs.233.91±169.98,p=0.040),and the difference on 2d was more significant(p<0.01).5.Comparison of postoperative complications:there was no significant difference in the incidence of continuous air leakage(p=1.000),atelectasis or pulmonary infection(p=0.604)and arrhythmia(p=0.471)between the accelerated rehabilitation surgery group and the control group.There was no significant difference in the total incidence of postoperative complications between the two groups(12.5%vs 22.22%,p=0.660).Conclusion:1.LVRS can improve lung function,dyspnea symptoms,exercise tolerance and quality of life in a short time.2.The application of ERAS concept in patients with LVRS can reduce surgical stress and postoperative inflammatory reaction;secondly,it can relieve postoperative pain,shorten operation time,encourage patients to get out of bed early,reduce postoperative pleural drainage,shorten postoperative catheter time,hospitalization time.3.Perioperative pulmonary rehabilitation exercise is beneficial to reduce the incidence of postoperative pulmonary complications.