目的 探讨肺预康复计划联合肺保护性通气策略对食管癌术后肺部并发症的影响。方法 选取2022年6月—2023年12月在潍坊市人民医接受腔镜下颈腹胸三切口食管癌切除（McKeown）手术的85例患者,采用随机数字表法分为两组。对照组（n=42）术前进行常规健康教育,术后常规呼吸训练及并发症预防,对心理、饮食、运动无特别建议。预康复组（n=43）患者在对照组基础上术前2周接受多模式干预方案,包括心理疏导、营养指导、呼吸训练、有氧运动。主要结局终点是术后7 d肺部并发症（肺炎、肺不张）的发生率,次要结局终点包括肺功能、胸腔引流管留置时间、住院时间。结果 两组患者在年龄、性别、美国麻醉医师协会（ASA）分级、术中出血量及手术时长方面的差异无统计学意义。与对照组相比,预康复组术后肺炎发生率低于对照组（t=4.435, P=0.035）,但两组间肺不张发生率差异无统计学意义。预康复组胸腔引流管留置时间（P=0.006）与住院时间（P=0.009）均短于对照组;术后7 d用力肺活量（FVC）,预康复组高于对照组（P=0.023）,但两组间第一秒用力呼气量（FEV1）差异无统计学意义（P>0.05）;术中人工气胸后吸气平台压（Pplat）,预康复组明显低于对照组（P<0.01）。结论 为期2周的预康复联合术中肺保护性通气策略对接受McKeown手术患者有明显获益,可以降低术后肺部并发症,减少胸腔引流管留置时间,缩短住院时间。
Objective To evaluate the effect of lung pre-rehabilitation program combined with lung protective ventilation strategy on postoperative pulmonary complications in patients with esophageal cancer. Methods A total of 85 patients underwent endoscopic surgery （McKeown） in Weifang People's Hospital from June 2022 to December 2023 were enrolled in the study, and according to the method of random number table, divided into two groups. The control group （n=42） received routine preoperative health education, postoperative respiratory training, and complication prevention, with no specific recommendations for psychology, diet, and exercise. The pre-rehabilitation group （n=43） received a multimodal intervention program two weeks before surgery on the basis of the control group, including psychological counseling, nutritional guidance, respiratory training, and aerobic exercise. The primary endpoint was the incidence of pulmonary complications （pneumonia, atelectasis） within 7 d after surgery, and the secondary endpoints included lung function, thoracic drainage tube indwelling time, and length of hospital stay. Results There were no significant differences in age, gender, American Society of Anesthesiologists （ASA） classification, intraoperative blood loss, and operation time between the two groups. Compared with the control group, the incidence of postoperative pneumonia was lower in the pre-rehabilitation group （t=4.435, P=0.035）, while there was no significant difference in the incidence of atelectasis. The thoracic drainage tube indwelling time （P=0.006） and length of hospital stay （P=0.009） were shorter in the pre-rehabilitation group than in the control group. The forced vital capacity （FVC） was higher in the pre-rehabilitation group than in the control group 7 d after surgery （P=0.023）, but there was no significant difference in forced expiratory volume in one second （FEV1） （P>0.05）. The platform pressure （Pplat） after artificial pneumothorax during surgery was significantly lower in the pre-rehabilitation group than in the control group （P<0.01）. Conclusion A two-week pre-rehabilitation combined with intraoperative lung protective ventilation strategy has significant benefits for patients with McKeown surgery, reducing postoperative pulmonary complications, thoracic drainage tube indwelling time, and hospitalization time.
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