探讨基于预康复(prehabilitation)和加速康复外科(enhanced recovery after surgery, ERAS)并经多维度管理模式对老年肺癌患者围术期康复及预后的影响。

选择2022年1月至2024年12月复旦大学附属华东医院收治的并接受肺癌手术切除的70例老年患者为研究对象。根据围术期的管理干预方法不同分为对照组32例和观察组38例。对照组患者针对有或无基础疾病，预康复方案采用，包括戒烟、有氧运动、纠正贫血、抗阻力训练、吸气肌训练、加强优化心理支持；观察组患者在对照组干预基础上提升功能残气量(functional residual capacity, FRC)、第一秒用力呼气量(forced expiratory volume in the first second, FEV₁)等。比较两组肺癌术后患者术后首次下床活动、肛门排气时间、术后住院天数、术后不同时相点疼痛视觉模拟评分(visual analogue scale, VAS)、术后并发症发生率及术后随访3~10个月生存情况。

两组肺癌患者肺功能检测结果比较无显著性差异(P>0.05)。观察组术后康复进程显著加快，其首次下床活动时间(28.55±8.33)h vs. (44.82±12.72)h、首次肛门排气时间(21.74±4.24)h vs.(32.91±5.64)h和术后住院天数(6.21±1.10)d vs.(9.03±1.93)d，两组比较具有统计学意义(P<0.01)；术后时相点(6 h、12 h、24 h及48 h)和视觉模拟评分两组比较有差异(P<0.05)。两组肺癌患者术后并发症发生率及随访3~10个月生存与病死率无统计学意义(P<0.05)。

在老年肺癌患者围术期管理中，整合预康复和ERAS理念并经多维度模式干预，有效加速患者术后康复、缩短住院时间，有效控制术后急性期胸痛具有临床意义。

To investigate the impact of a multidimensional management model based on prehabilitation and Enhanced Recovery After Surgery (ERAS) protocols on perioperative rehabilitation and prognosis in elderly patients undergoing lung cancer surgery.

Seventy elderly patients who underwent lung cancer resection in our Hospital from January 2022 to December 2024 were enrolled. According to different perioperative management interventions, they were divided into a control group (32 cases) and an observation group (38 cases). Patients in the control group received a prehabilitation program tailored to their comorbidities, including smoking cessation, aerobic exercise, anemia correction, resistance training, inspiratory muscle training, and enhanced psychological support. The observation group received additional interventions aimed at improving functional residual capacity (FRC) and forced expiratory volume in the first second (FEV₁) based on the control group′s protocol. The following parameters were compared between the two groups: time to first ambulation, time to first flatus, postoperative hospital stay, pain visual analogue scale (VAS) scores at different postoperative time points (6 h, 12 h, 24 h, 48 h), incidence of postoperative complications, and survival status during a 3-10 month follow-up.

There was no significant difference in preoperative pulmonary function test results between the two groups (P>0.05). The postoperative recovery process was significantly accelerated in the observation group. The time to first ambulation (28.55±8.33 hours vs. 44.82±12.72 hours), time to first flatus (21.74±4.24 hours vs. 32.91±5.64 hours), and postoperative hospital stay (6.21±1.10 days vs. 9.03±1.93 days) were all significantly shorter in the observation group (P<0.01). VAS pain scores at all measured postoperative time points were significantly lower in the observation group (P<0.05). However, there were no statistically significant differences between the two groups in the incidence of postoperative complications or in survival/mortality rates during the 3-10 month follow-up (P>0.05).

In the perioperative management of elderly lung cancer patients, integrating prehabilitation and ERAS concepts through a multidimensional intervention model can effectively accelerate postoperative recovery, shorten hospital stays, and improve acute postoperative pain control, demonstrating significant clinical value.