| 摘要: | 背景：初診斷肺癌及良性腫瘤之主要治療方式為手術切除，而肺部手術後易產生痰液蓄積導致肺部發炎等術後併發症出現。近年來研究發現，運動訓練在肺復原計畫中發揮著越來越重要的作用，運動介入可增加運動能力、肌肉力量及體力和提升生活品質。國外經驗顯示術前呼吸訓練、調整生活方式及復健計畫的介入構成肺部腫瘤術後患者復原的關鍵因素。目前台灣臨床僅針對肺部腫瘤切除術後執行復健計畫，對於手術前肺部復健運動成效尚無相關實證資料。
研究目的：本研究旨在探討參加術前肺部復健運動計畫，對接受肺部腫瘤手術的病人術後之焦慮程度、憂鬱、肺功能、早期活動等級、肌肉力量及體能狀態的影響。
研究方法：本研究採用隨機分派平行臨床試驗設計，針對診斷肺腫瘤病人，欲接受腫瘤切除術的病人進行試驗。實驗組病人參加術前居家復健計畫；控制組病人術前不接受任何介入，術後兩組皆接受常規術後肺部復健計畫。使用描述性統計分析基本人口學特徵；採廣義估計方程式(generalized estimating equations, GEE)分析兩組焦慮及憂鬱程度、肺功能、下肢肌力、上肢握力，以卡方檢定比較術後隔天早期活動等級及日常體能狀態。
研究結果：研究收案102位病人進行隨機分組，最終86位完成試驗；實驗組及控制組各43位。平均介入時間為19天，經介入後實驗組尖峰呼氣流速顯著高、FEV1/ FVC%小於控制組病人；但兩組的握力、下肢肌力、活動等級、日常體能狀態、焦慮與憂鬱變化結果皆未達到統計上顯著差異。然而兩組進一步分析發現，診斷為良性及治療期間是焦慮的主要影響因子。
結論：在台灣導入術前肺部復健運動為可行方案，診斷良性及治療期間是影響焦慮的主要因素，此外肺部腫瘤病人術前介入的肺部復健運動對於肺功能有助益，建議未來可更聚焦於特定術式、癌期病人及手術全期進行進一步的研究。
Background: The primary treatment for the initial diagnosis of lung cancer and benign tumors is surgical resection. However, post-operative complications, such as the accumulation of sputum leading to lung inflammation, frequently occur after surgical treatment. Postoperative exercise interventions can improve exercise capacity, muscle strength, physical fitness, and quality of life. International experience indicates that preoperative respiratory training, lifestyle adjustments, and the implementation of rehabilitation programs are crucial factors for the recovery of patients following lung tumor surgery. Currently, clinical practice in Taiwan focuses solely on rehabilitation programs after lung tumor resection, with no empirical data available regarding the effectiveness of preoperative pulmonary rehabilitation exercises.
Objective: This study aims to explore how participating in a preoperative pulmonary rehabilitation exercise program affects post-operative lung function, early activity level, muscle strength, performance status, and levels of depression and anxiety in patients undergoing lung tumor removal surgery.
Methods: This study adopted a randomized controlled trial design targeting patients diagnosed with lung tumors who were scheduled for tumor resection surgery. Patients in the experimental group participated in a preoperative home-based rehabilitation program while patients in the control group received no preoperative interventions. Both groups received postoperative pulmonary rehabilitation programs. Descriptive statistics were used to analyze basic demographic characteristics. Generalized estimating equations were employed to analyze the anxiety and depression levels, lung function, lower limb muscle strength, and grip strength of the two groups. Chi-square tests were used to compare the early activity levels and performance status.
Results: The study enrolled 102 patients who were randomized into groups, with 86 ultimately completing the trial; 43 each in the experimental and control groups. The average preoperative intervention period was 19 days. Following intervention, the experimental group showed significantly higher peak expiratory flow rates and a lower ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) compared to the control group. However, there were no statistically significant differences between the two groups in grip strength, lower limb muscle strength, activity level, performance status, and changes in anxiety and depression scores. Further analysis revealed that diagnosis of benign tumors and anxiety during treatment were the primary influencing factors.
Conclusions: Introducing preoperative pulmonary rehabilitation exercises in Taiwan is a feasible approach. The primary factors influencing anxiety are the diagnosis of benign tumors and the duration of the treatment process. Additionally, preoperative pulmonary rehabilitation exercises benefit lung function in patients with lung tumors. Future research should focus more specifically on particular surgical procedures, cancer stages, and the perioperative period. |
