作业疗法在非小细胞肺癌患者术后康复中应用分析

doi:10.3877/cma.j.issn.1674-6902.2024.03.013

目的

分析作业疗法对非小细胞肺癌(non-small cell lung cancer, NSCLC)术后康复的临床疗效。

方法

选择2022年11月至2023年11月我院收治的62例NSCLC患者，术后采取常规肺功能康复训练为对照组30例，在对照组基础上采用作业疗法为观察组32例。检测两组治疗前后用力肺活量(the forced vital capacity, FVC)、呼气高峰流量(peak expiratory flow, PEF)、最大通气量(maximal voluntary ventilation, MVV)等肺功能情况；检测6 min步行距离(6-minute walk distance, 6MWD)；采用日常生活活动量表(activity of daily living, ADL)判断两组生活能力；统计两组健康行为达标率；采用肺癌患者生活质量测定量表(functional assessment of cancer therapy-lung, FACT-L)评价两组治疗前后生活质量。

结果

观察组治疗前、治疗2个月后、治疗3个月后FVC分别为(1.34±0.19)L、(1.82±0.21)L、(2.36±0.24)L，对照组治疗前、治疗2个月后、治疗3个月后FVC分别为(1.33±0.18)L、(1.39±0.25)L、(1.83±0.22)L，观察组FVC高于对照组(P<0.05)；观察组治疗前、治疗2个月后、治疗3个月后PEF分别为(165.28±33.07)L/min 、(195.30±31.27)L/min 、(230.64±38.18)L/min ，对照组治疗前、治疗2个月后、治疗3个月后PEF分别为(163.90±30.25)L/min 、(170.25±29.53)L/min 、(194.48±35.03)L/min ，观察组PEF高于对照组(P<0.05)；观察组治疗前、治疗2个月后、治疗3个月后MVV分别为(47.19±9.92)L、(58.43±10.35)L、(68.19±13.05)L，对照组治疗前、治疗2个月后、治疗3个月后MVV分别为(46.02±8.36)L、(50.21±9.27)L、(58.34±11.14)L，观察组MVV高于对照组(P<0.05)；观察组治疗后6MWD(438.83±38.22)m高于对照组(389.36±36.24)m(P<0.05)；观察组治疗后ADL评分(63.65±2.94)分高于对照组(59.83±2.15)分(P<0.05)；观察组治疗后健康行为达标率规范饮食81.25%、适宜运动87.50%、遵医用药84.38%、定期复查90.63%和睡眠休息84.38%高于对照组(63.33%、73.33%、66.67%、76.67%、66.67%)(P<0.05)；观察组治疗后FACT-L评分较对照组改善(P<0.05)。

结论

作业疗法可有效提高NSCLC患者术后肺功能康复训练效果，改善生活质量具有临床意义。

关键词: 非小细胞肺癌, 作业疗法, 功能障碍, 康复医学

Objective

To retrospectively analyze the effect of occupational therapy on postoperative rehabilitation of patients with non-small cell lung cancer (NSCLC).

Methods

A total of 62 patients with NSCLC admitted to our hospital from November 2022 to November 2023 were selected. Among them, 30 patients were treated with routine pulmonary function rehabilitation training after surgery as the control group, and 32 patients were treated with occupational therapy for 3 months on the basis of that as the observation group. The pulmonary function such as forced vital capacity (FVC), peak expiratory flow (PEF) and maximum ventilation (MVV) were detected before and after treatment in the two groups. The 6-minute walking distance (6MWD) was measured. The activities of daily living scale (ADL) was used to evaluate the living ability of the two groups. The compliance rate of health behavior of the two groups was counted. Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to evaluate the quality of life of the two groups before and after treatment.

Result

The FVC of the observation group before treatment, 2 months after treatment and 3 months after treatment were (1.34±0.19) L, (1.82±0.21) L and (2.36±0.24)L, respectively. The FVC of the control group before treatment, 2 months after treatment and 3 months after treatment were (1.33±0.18)L, (1.39±0.25) L and (1.83±0.22) L, respectively. The FVC of the observation group was higher than that of the control group (P<0.05). The PEF of the observation group before treatment, 2 months after treatment and 3 months after treatment were (165.28±33.07) L/min, (195.30±31.27) L/min and (230.64±38.18) L/min, respectively. The PEF of the control group before treatment, 2 months after treatment and 3 months after treatment were (163.90±30.25) L/min, (170.25±29.53) L/min and (194.48±35.03) L/min, respectively. The PEF of the observation group was higher than that of the control group (P<0.05). The MVV of the observation group before treatment, 2 months after treatment and 3 months after treatment were (47.19±9.92) L, (58.43±10.35) L and (68.19±13.05) L, respectively. The MVV of the control group before treatment, 2 months after treatment and 3 months after treatment were (46.02±8.36) L, (50.21±9.27) L and (58.34±11.14) L, respectively. The MVV of the observation group was higher than that of the control group (P<0.05). After treatment, the 6MWD of the observation group (438.83±38.22) m was significantly higher than that of the control group (389.36±36.24) m(P<0.05); After treatment, the ADL score of the observation group (63.65±2.94) was significantly higher than that of the control group (59.83±2.15), P<0.05; After treatment, the compliance rate of health behavior in the observation group (81.25%, 87.50%, 84.38%, 90.63%, 84.38%) was significantly higher than that in the control group (63.33%, 73.33%, 66.67%, 76.67%, 66.67%), P<0.05. After treatment, the FACT-L score of the observation group was significantly improved compared with the control group (P<0.05).

Conclusion

Occupational therapy can effectively improve the effect of postoperative pulmonary function rehabilitation training in patients with NSCLC and improve the quality of life of patients, which has certain clinical promotion value.

Key words: Non-small cell lung cancer, Occupational therapy, Dysfunction, Rehabilitation medicine

表1 两组NSCLC患者临床资料比较[n(%)，(

±s)]

临床资料	观察组(n＝32)	对照组(n＝30)	t/χ²	P值
性别			0.053	0.818
男	18(56.25)	16(53.33)
女	14(43.75)	14(46.67)
年龄(岁)	56.26±11.89	58.09±12.61	0.739	0.524
体重质量指数(kg/m²)	22.43±2.94	22.17±3.02	0.942	0.371
手术切除部位			0.827	0.843
上叶	15(46.87)	13(43.33)
中叶	3(9.38)	2(6.67)
下叶	11(34.38)	10(33.33)
部分楔形切除	3(9.37)	5(16.67)
病理类型			0.046	0.830
鳞癌	6(18.75)	5(16.67)
腺癌	26(81.25)	25(83.33)
TNM分期			0.176	0.916
Ⅰ	13(40.63)	12(40.00)
Ⅱ	16(50.00)	16(53.33)
Ⅲ	3(9.37)	2(6.67)

表1 两组NSCLC患者临床资料比较[n(%)，(

±s)]

临床资料	观察组(n＝32)	对照组(n＝30)	t/χ²	P值
性别			0.053	0.818
男	18(56.25)	16(53.33)
女	14(43.75)	14(46.67)
年龄(岁)	56.26±11.89	58.09±12.61	0.739	0.524
体重质量指数(kg/m²)	22.43±2.94	22.17±3.02	0.942	0.371
手术切除部位			0.827	0.843
上叶	15(46.87)	13(43.33)
中叶	3(9.38)	2(6.67)
下叶	11(34.38)	10(33.33)
部分楔形切除	3(9.37)	5(16.67)
病理类型			0.046	0.830
鳞癌	6(18.75)	5(16.67)
腺癌	26(81.25)	25(83.33)
TNM分期			0.176	0.916
Ⅰ	13(40.63)	12(40.00)
Ⅱ	16(50.00)	16(53.33)
Ⅲ	3(9.37)	2(6.67)

表2 两组NSCLC患者治疗前后肺功能比较(

±s)

组　别	治疗前后	FVC(L)	PEF(L/min)	MVV(L)
观察组	治疗前	1.34±0.19	165.28±33.07	47.19±9.92
	治疗2个月	1.82±0.21^a	195.30±31.27^a	58.43±10.35^a
	治疗3个月	2.36±0.24^a	230.64±38.18^a	68.19±13.05^a
对照组	治疗前	1.33±0.18	163.90±30.25	46.02±8.36
	治疗2个月	1.39±0.25^a	170.25±29.53^a	50.21±9.27^a
	治疗3个月	1.83±0.22^a	194.48±35.03^a	58.34±11.14^a
F_时间		9.815	11.489	8.334
F_交互		31.060	42.722	63.519
F_组间		11.237	14.312	18.115
P值		0.000	0.000	0.000

表2 两组NSCLC患者治疗前后肺功能比较(

±s)

组　别	治疗前后	FVC(L)	PEF(L/min)	MVV(L)
观察组	治疗前	1.34±0.19	165.28±33.07	47.19±9.92
	治疗2个月	1.82±0.21^a	195.30±31.27^a	58.43±10.35^a
	治疗3个月	2.36±0.24^a	230.64±38.18^a	68.19±13.05^a
对照组	治疗前	1.33±0.18	163.90±30.25	46.02±8.36
	治疗2个月	1.39±0.25^a	170.25±29.53^a	50.21±9.27^a
	治疗3个月	1.83±0.22^a	194.48±35.03^a	58.34±11.14^a
F_时间		9.815	11.489	8.334
F_交互		31.060	42.722	63.519
F_组间		11.237	14.312	18.115
P值		0.000	0.000	0.000

表3 两组NSCLC患者治疗前后6MWD比较[(

±s)，m]

治疗前后	观察组(n＝32)	对照组(n＝30)	t值	P值
治疗前	275.34±20.19	271.37±19.18	0.335	0.439
治疗2个月后	378.33±32.25^a	330.82±28.21^a	4.198	0.028
治疗3个月后	438.83±38.22^a	389.36±36.24^a	6.301	0.009

表3 两组NSCLC患者治疗前后6MWD比较[(

±s)，m]

治疗前后	观察组(n＝32)	对照组(n＝30)	t值	P值
治疗前	275.34±20.19	271.37±19.18	0.335	0.439
治疗2个月后	378.33±32.25^a	330.82±28.21^a	4.198	0.028
治疗3个月后	438.83±38.22^a	389.36±36.24^a	6.301	0.009

表4 两组NSCLC患者健康行为达标率比较[n(%)]

组　别	例数	规范饮食	适宜运动	遵医用药	定期复查	睡眠休息
观察组	32	26(81.25)	28(87.50)	27(84.38)	29(90.63)	27(84.38)
对照组	30	19(63.33)	22(73.33)	20(66.67)	23(76.67)	20(66.67)
χ²值		4.758	4.026	6.269	4.614	5.151
P值		0.029	0.045	0.012	0.032	0.023

表4 两组NSCLC患者健康行为达标率比较[n(%)]

组　别	例数	规范饮食	适宜运动	遵医用药	定期复查	睡眠休息
观察组	32	26(81.25)	28(87.50)	27(84.38)	29(90.63)	27(84.38)
对照组	30	19(63.33)	22(73.33)	20(66.67)	23(76.67)	20(66.67)
χ²值		4.758	4.026	6.269	4.614	5.151
P值		0.029	0.045	0.012	0.032	0.023

表5 两组NSCLC患者治疗前后FACT-L 4.0评分比较(

±s)

组　别	例数	生理状况		社会家庭状况		情感状况		功能状况
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	18.12±3.48	9.76±2.42^a	9.09±1.94	22.93±3.97^a	16.44±1.93	9.15±2.18^a	10.02±1.73	22.32±2.34^a
对照组	30	17.01±3.19	12.15±2.61^a	8.10±1.83	18.24±3.11^a	17.02±2.26	11.98±2.06^a	9.43±2.07	19.17±2.06^a
t值		0.519	4.281	0.602	7.092	0.566	4.320	1.059	5.014
P值		0.604	0.005	0.597	0.000	0.601	0.004	0.063	0.002

表5 两组NSCLC患者治疗前后FACT-L 4.0评分比较(

±s)

组　别	例数	生理状况		社会家庭状况		情感状况		功能状况
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	18.12±3.48	9.76±2.42^a	9.09±1.94	22.93±3.97^a	16.44±1.93	9.15±2.18^a	10.02±1.73	22.32±2.34^a
对照组	30	17.01±3.19	12.15±2.61^a	8.10±1.83	18.24±3.11^a	17.02±2.26	11.98±2.06^a	9.43±2.07	19.17±2.06^a
t值		0.519	4.281	0.602	7.092	0.566	4.320	1.059	5.014
P值		0.604	0.005	0.597	0.000	0.601	0.004	0.063	0.002

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Application of occupational therapy in postoperative rehabilitation of patients with non-small cell lung cancer

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Application of occupational therapy in postoperative rehabilitation of patients with non-small cell lung cancer