[[alternative]]Testing Efficacy of A Pulmonary Rehabilitation Program for Post-operative Oxygenation and Pulmonary Complications Following Lung Cancer Resection Surgery

[[abstract]]背景：肺癌切除術病人因換氣肺泡數量減少造成肺功能下降，易引起術後肺部合併症，肺部復健運動可能有助於提升其術後氧合能力與減少術後肺部合併症。研究目的：探討肺部復健介入措施對肺癌術後病人的氧合能力、預防術後肺部合併症、疲倦與有氧耐力及肺部復原之成效。研究方法：北部某醫學中心胸腔外科招募90位個案參與。隨機分配至介入組或對照組，對照組接受常規護理指導；介入組除常規護理指導與物理治療外，由術前5天及術後5天每天2次肺部復健介入。兩組分別於手術前與出院前進行研究問卷填寫、疲倦量表與六分鐘步行測試，於出院前由研究人員自病歷摘錄個案之疾病特性、住院期間周邊血氧濃度與氧氣使用濃度、術後併發症、胸管存留時間與住院天數等資料。以描述性統計分析個案基本資料、疾病變項及主要測量變項；以卡方檢定、t檢定分析兩組間前測資料同質性，以GEE比較兩組氧合功能隨時間變化之組間差異，另以卡方檢定分析兩組在肺部併發症差異，以獨立t檢定分析兩組在胸管存留時間、住院天數、疲倦與六分鐘走路距離之差異相關。研究結果：兩組個案的基本屬性、前測氧合能力與疲倦程度無明顯差異，顯示兩組間的同質性，但前測六分鐘步行距離實驗組顯著高於對照組。廣義線性模式結果顯示氧合功能有顯著之組別、時間以及組別與時間的交互作用，介入組比對照組之β值為34.13 (Wald X2 = 8.32, p = 0.04)。發生肺部併發症的人數介入組有1人明顯少於控制組有10人(X2 = 8.389, p =0.004 )。介入組的胸管留存時間為2.00 ±1.00天明顯少於對照組的2.56 ±1.25天(t =-2.324 , p = 0.022)，住院天數兩組無明顯差異。而在六分鐘步行距離兩組無明顯差異，而術後疲倦程度方面介入組後測疲倦程度明顯低於對照組為。結論：肺部復健介入措施可幫助肺癌病人減少手術造成的氧合能力下降、降低術後肺部併發症之發生、縮短胸管留置時間以及改善術後疲倦程度。[[abstract]]Background: Lobectomy of lungs is the primary treatment for non-small cell lung cancer. Pulmonary rehabilitation enhancing lung expansion and ventilation may help to improve oxygenation and reduce postoperative lung complications. Aim: The study was to test the efficacy of a pulmonary rehabilitation intervention on oxygenation, pulmonary complications in lung cancer patients with lung resection surgery.Methods: 90 lung cancer patients scheduled for a lung resection surgery were recruited and randomized to the control or intervention group. The intervention group practiced pulmonary rehabilitation exercise in home for 5 days before the surgery and post-operative pulmonary rehabilitation while in the hospital. Data on six minute walk distance and level of fatigue were collected at the baseline and before discharge. Descriptive analyses were used to describe patients’ demographics, disease variables, and outcome variables. The Chi-square, T-test, and GEE were used to test the efficacy of the study interventions. Results: Two groups were similar at baseline. The result of GEE showed signification group, time, and group by time interaction effects on S/F ratio, indicating the intervention group had better oxygenation with a β value of 34.13 (Wald X2 = 8.32, p = 0.04) compared with the control group. There was only one patient in the intervention group reported clinical significant postoperative lung complications (X2 = 8.389, p = 0.004 ) than what was reported in the control group. The average duration of chest drainage in the intervention group was 2.00 days (t =-2.324 , p = 0.022).Conclusion: The study results were provided evidence of the pulmonary rehabilitation intervention for improved oxygenation, reduced postoperative pulmonary complications in lung cancer with lung resection patients