围术期肺康复对肺癌患者术后疗效的Meta分析

目的 使用Meta分析评价围术期常规治疗联合肺康复与仅使用常规治疗对肺癌患者的术后疗效。方法 通过计算机检索PubMed、中国知网（CNKI）、维普科技期刊数据库(VIP)和万方医学网等数据库，检索时间截至2022年1月，纳入肺康复对肺癌患者术后疗效的临床随机对照试验。对所有文献进行筛选、资料提取并依据Cochrane系统进行质量评价，采用RevMan5.4软件、Stata15.0软件进行Meta分析。结果 共纳入15篇文献，共计1448例患者，研究结果显示：较常规治疗相比，联合肺康复治疗能更有效的改善肺癌患者的肺功能状态第1秒用力呼气容积（WMD=0.58，95%CI：0.36~0.80，P＜0.00001）、用力肺活量（WMD=0.61，95%CI：0.30~0.92，P＝0.00001）、第1秒用力呼气容积占用力肺活量比（WMD=5.63，95%CI：1.48~9.78，P＝0.008）、第1秒用力呼气容积占预计值百分比（WMD=4.39，95%CI：1.22~7.55，P＝0.007）、最大通气量（WMD=7.79，95%CI：2.89~12.68，P＝0.002）]，提高6分钟步行距离（WMD=45.46，95%CI：20.43~70.48，P＝0.0004）、缩短住院时间（WMD=-2.17，95%CI：-2.47~-1.87，P＜0.00001）。纳入15篇文献中，9篇提到了术后并发症，经常规治疗联合肺康复的肺癌患者术后发生支气管胸膜瘘（1例）、呼吸衰竭（1例）、肺炎和肺不张（3例）；仅常规治疗的肺癌患者术后发生支气管胸膜瘘（5例）、肺炎和肺不张（5例）、呼吸衰竭（4例）、心力衰竭（1例）、心律失常（1例）、术后疼痛（1例）、呕吐及腹泻（1例），差异有统计学意义。结论 与常规治疗相比，联合物理治疗肺康复能更有效的改善肺癌患者的术后疗效，其显著改善了肺功能各项指标、6分钟步行距离和住院时间，同时，减少了术后并发症，其临床疗效及安全性得到了证实，在临床上应用价值高。

Meta-analysis of perioperative pulmonary rehabilitation in patients with lung cancer

Objective To evaluate the postoperative efficacy of conventional therapy combined with perioperative pulmonary rehabilitation and conventional therapy alone in patients with lung cancer using meta-analysis. Methods PubMed, CNKI, VIP, Wanfang Medical Network and other databases were searched by computer until January 2022. Randomized controlled clinical trials on the postoperative efficacy of pulmonary rehabilitation for lung cancer patients were included. All literatures were screened and extracted, and quality evaluation was carried out according to the Cochrane system. Meta-analysis was performed using RevMan5.4 software and Stata15.0 software. Results A total of 1448 patients were included in 15 literatures. The results showed that compared with conventional treatment, combined pulmonary rehabilitation therapy could improve lung function more effectively in patients with lung cancer forced expiratory volume in 1 second (WMD=0.58, 95%CI: 0.36~0.80, P < 0.00001), forced vital capacity (WMD=0.61, 95%CI: 0.30~0.92, P = 0.00001), ratio of forced expiratory volume to forced vital capacity in the first second (WMD=5.63, 95%CI: 1.48-9.78, P = 0.008), percentage of forced expiratory volume in the first second to the estimated value (WMD=4.39, 95%CI: 1.22-7.55, P = 0.007), maximum volume of gas (WMD=7.79, 95%CI: 2.89-12.68, P = 0.002)], improved 6-minute walking distance (WMD=45.46, 95%CI: 20.43-70.48, P = 0.0004), and shortened length of hospital stay (WMD=-2.17, 95%CI: -2.47-1.87, P < 0.00001). Among the 15 included literatures, 9 mentioned postoperative complications, including bronchopleural fistula (1 case), respiratory failure (1 case), pneumonia and atelectasis (3 cases) in patients with lung cancer who underwent conventional treatment combined with pulmonary rehabilitation. Only the patients with conventional treatment of lung cancer had bronchopleural fistula (5 cases), pneumonia and atelectasis (5 cases), respiratory failure (4 cases), heart failure (1 case), arrhythmia (1 case), postoperative pain (1 case), vomiting and diarrhea (1 case), and the difference was statistically significant. Conclusion Compared with conventional treatment, combined physical therapy for lung rehabilitation can improve the postoperative efficacy of lung cancer patients more effectively, which significantly improves the indicators of lung function, 6-minute walking distance and length of hospital stay, and at the same time, reduces postoperative complications. Its clinical efficacy and safety have been confirmed, and its clinical application value is high.