Application Of Postoperative Respiratory Rehabilitation In Patients Undergoing Double-hole Thoracoscopic Pneumonectomy With ERAS Concept

Background and objective:Surgery is still the preferred treatment for early lung cancer.Postoperative pulmonary complications(PPCs)are the main factors leading to high mortality and increased hospitalization costs.Even with minimally invasive thoracic surgery and perioperative protective ventilation strategies,the incidence of PPCs is still 12%-50%.Enhanced recovery after surgery(ERAS)reduce complications,shorten hospital stay,reduce medical costs and make patients recover quickly through a series of perioperative management measures with evidence-based medical evidence for surgical patients.Potential mechanisms including atelectasis,the decrease of mucociliary clearance and respiratory muscle function lead to PPCs.Pulmonary rehabilitation(PR)throughout the perioperative period is one of the core links of ERAS,the former includes respiratory rehabilitation,of which the airway clearance technology can promote lung recruitment and clear airway secretions.In this study,we retrospectively analyzed the short-term postoperative respiratory rehabilitation training of patients with double-hole thoracoscopic lung resection using active cycle of breathing technology(ACBT),oscillatory positive expiratory pressure(OPEP)device-Acapella choice PEP combined with leventon incentive lung volume instrument under the concept of ERAS,and the incidence of postoperative pulmonary complications,postoperative recovery and hospitalization costs were analyzed from the perspective of chest imaging and inflammatory biomarkers,and the risk factors and pathogenesis of PPCs were discussed.Materials and Methods:We retrospectively collected the clinical data of 146 patients undergoing pneumonectomy under double-hole thoracoscope in the department of thoraco-cardiac surgery of the second affiliated hospital of Chongqing Medical University from September,2019 to September,2020,all of which were managed in perioperative period under ERAS concept,and then they were divided into observation group(OG)and control group(CG)according to whether they received respiratory rehabilitation training after surgry.The former also received respiratory rehabilitation training including active cycle of breathing technique(ACBT),Acapella choice PEP and leventon-activated lung volumeter at least 1-3 days after surgry.We compared the differences between the two groups in the incidence of PPCs,postoperative recovery,hospitalization cost,etc.were compared,and carried out subgroup analysis in the observation group to find out the risk factors of PPCs.Results :The incidence of pulmonary exudation in the OG on the 3rd day after surgery was lower than that in the CG(17.6% vs 31.9%,P < 0.05),and compared with the CG,the OG showed more improvement in pulmonary plaque(20.3% vs 0.42%,P<0.05)and pulmonary exudation(45.5% vs8.6%,P<0.05)on the 3rd day after surgery than on the 1st day after surgery.WBC(7.85±2.72 vs 8.74 ± 1.97,P<0.05)(*10^ 9/L)and Neu%(70.78±13.53 vs 74.54 ± 6.38,P<0.05)(%)on the 3rd day in the OG were obviously lower than those in the CG after surgery.The postoperative catheter extraction time(0.71±1.15 vs 1.08±1.72,P<0.05)(d),the first drinking time(0.12±0.33 vs 0.35±0.51,P<0.05)(d)and postoperative antibiotic use time(9.10±3.74 vs 10.67±4.57,P<0.05)in the OG were shorter than those in the CG,and the total postoperative hospitalization expensesin(7.01±1.94 vs 7.68±1.91,P<0.05)(10 thousand)was cheeper than that in the CG.The OG was divided into less PPSc group and more PPCs groups,and univariate analysis showed that smoking and BMI were obviously different between the two groups.We then regarded both of them as independent variables and PPCs as dependent variables for binary logstic regression analysis,finding that BMI plays a decisive role(P<0.05).Conclusion:Under the concept of ERAS,respiratory rehabilitation of 3 days after surgery can reduce the imaging manifestations and inflammatory indexes of pneumonia on the 3rd days after surgery,shorten the time of catheter extraction and first drinking water,reduce the time of postoperative antibiotic use and hospitalization expenses,so as to play a role in rapid rehabilitation.Smoking and BMI were the main factors affecting the number of PPCs in the OG,and BMI played a decisive role.