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目的探讨肺康复训练前后肺癌患者血清肺表面活性蛋白D(SP-D)改变与术后肺部并发症(postoperative pulmonary complications,PPC)的相关性。方法纳入华西医院胸外科2015年3~12月连续收治的合并高危因素且行手术治疗的非小细胞肺癌患者80例,随机分为康复组[36例,男25例、女11例,平均年龄(63.98±8.32)岁]和对照组[44例,男32例、女12例,平均年龄(64.58±6.71)岁]。康复组行1周的术前肺康复训练,分析两组患者术后PPC、血清SP-D浓度。结果康复组PPC发生率低于对照组,且差异有统计学意义(5.56%vs.22.73%,P=0.032),康复组肺康复前后血清SP-D水平下降幅度[(30.75±5.57)ng/ml vs.(24.22±3.08)ng/ml高于对照组(31.16±7.81)ng/ml vs.(30.29±5.80)ng/ml,P=0.012];非PPC组术前血清SP-D水平下降幅度显著高于PPC组(P=0.012)。结论术前肺康复训练可以降低肺癌合并高危因素患者术后并发症发生率,血清SP-D水平变化程度可作为肺康复训练的评价指标。
Objective To investigate the correlation between the changes of serum pulmonary surfactant protein D (SP-D) and postoperative pulmonary complications (PPC) in patients with lung cancer before and after pulmonary rehabilitation training. Methods Totally 80 patients with non-small cell lung cancer who were admitted to West China Hospital of Thoracic Surgery from March 2015 to December 2015 were randomly divided into rehabilitation group (36 cases, 25 males and 11 females, mean age ( 63.98 ± 8.32) years old and control group (44 cases, 32 males and 12 females, average age 64.58 ± 6.71 years). The rehabilitation group was given a one-week preoperative pulmonary rehabilitation training. The postoperative PPC and serum SP-D concentrations in both groups were analyzed. Results The incidence of PPC in rehabilitation group was lower than that in control group (5.56% vs.22.73%, P = 0.032). The decrease of SP-D level in rehabilitation group before and after pulmonary rehabilitation [(30.75 ± 5.57) ng / ml vs 24.22 ± 3.08 ng / ml, respectively (31.16 ± 7.81 ng / ml vs. 30.29 ± 5.80 ng / ml, P = 0.012]. The preoperative serum SP-D level was lower in non-PPC group The amplitude was significantly higher than the PPC group (P = 0.012). Conclusions Preoperative pulmonary rehabilitation can reduce the incidence of postoperative complications in patients with lung cancer complicated with high risk factors. The level of serum SP-D can be used as the evaluation index of rehabilitation training in lung.