Abstract
背景与目的振动正压呼气（oscillatory positive expiratory pressure, OPEP）训练是一种通过正压呼气装置（acapella）进行的呼吸训练。OPEP在慢性阻塞性肺疾病、支气管扩张症、肺囊肿等疾病的临床价值已经得到广泛探讨，但其在肺癌手术患者围术期的应用价值尚有待探索。本研究旨在探索围术期进行振动正压呼气训练对胸腔镜肺癌患者术后并发症发生率、肺功能、生活质量的影响。方法前瞻性收集2017年9月15日-2018年1月15日四川大学华西医院胸外科单个医疗组行胸腔镜肺叶切除的原发性非小细胞癌患者69例，随机分成实验组（35例）和对照组（34例）。实验组（acapella group, AG）围手术期采用振动正压呼气训练，对照组（control group, CG）进行常规围术期处理。对比分析两组在术后并发症发生率、肺功能、生活质量方面的差异。结果术后肺部并发症和肺不张在AG（2.9%, 0.0%）显著低于CG（20.6%, 14.7%）（P=0.03, P=0.03）；平均住院日和术后住院日在AG（10.86±5.64, 5.09±4.55）d显著短于CG（14.41±4.58, 7.59±3.21）d（P=0.01, P=0.01）；住院药物费用在AG（4, 413.60±1, 772.35）￥显著低于CG（6, 490.35±3, 367.66）￥（P=0.01）。出院当日第1秒用力呼气容积（forced expiratory volume in the first second, FEV1）和呼气峰流速（peak expiratory flow, PEF）在AG[(1.50±0.32) L, (252.06±75.27) L/min]显著高于CG[(1.34±0.19) L, (216.94±49.72) L/min]（P=0.03, P=0.03）。结论肺癌患者围手术期使用振动正压呼气训练有助于降低肺部并发症，同时能够加速患者康复。
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