Clinical application of pulmonary rehabilitation management in postoperative pulmonary infection after minimally invasive esophagectomy

doi:10.3877/cma.j.issn.1674-6902.2025.06.016

Abstract

Abstract:

Objective

To analyze the clinical efficacy of pulmonary rehabilitation training management in patients with postoperative pulmonary infection after laparoscopic esophagectomy for esophageal cancer.

Method

A total of 49 patients who underwent thoracoscopic esophagectomy at the Second Medical Center of the General Hospital of the People′s Liberation Army from June 2023 to February 2025 were selected as the subjects. 25 patients received perioperative clinical nursing management as the control group, and 24 patients received pulmonary rehabilitation training management on the basis of the control group as the observation group. between two groups Forced Expiratory Volume in One Second and percentage of forced vital capacity(FEV₁/FVC%), peak expiratory flow(PEF), partial pressure of oxygen(PaO₂), partial pressure of carbon dioxide(PaCO₂), oxygen saturation(SaO₂), step count(SC), Respiration(R)and Heart Rate(HR); Record two groups of pulmonary complications.

Result

Before surgery, the FEV₁/FVC% (59.17±3.86)% and PEF (4.36±0.34) L/s in the observation group were higher than those in the control group (56.64±3.70)% and PEF (4.11±0.38) L/s (P<0.05); The FEV₁/FVC% (64.08±4.42)% and PEF(4.52±0.37) L/s in the observation group were higher than those in the control group after surgery (59.32±4.02)% and (4.19±0.37)L/s, respectively (P<0.01). Before surgery, the PaO₂ (74.28±17.21) mmHg and PaCO₂ (55.69±8.17) mmHg in the observation group were better than those in the control group (71.59±15.39) mmHg and PaCO₂ (57.79±6.59) mmHg (P>0.05), and the SaO₂ (92.34±15.62)% was higher than that in the control group (91.87±13.75)% (P<0.05); The PaO₂ (78.24±16.87) mmHg and PaCO₂ (48.41±9.25) mmHg of the observation group were better than those of the control group after surgery (74.38±14.62) mmHg and (52.83±7.15) mmHg, respectively (P>0.05); SaO₂ (94.84±18.35)% was higher than the control group (91.65±14.68)% (P>0.05). Before surgery, the SC (1 120.96±95.82), R (31.21±6.40) min, and HR (102.71±20.39) min of the observation group were better than those of the control group SC(1 052.00±85.85), R (35.64±5.99) min, and HR (116.96±21.83) min (P<0.05); After surgery, the SC(1 443.96±85.74), R (26.46±6.35) min, and HR (89.83±18.06) min in the observation group were better than those in the control group SC(1 260.24±81.13), R (32.16±6.97) min, and HR (108.64±25.30) min (P<0.01). During hospitalization, there were 3 cases (12.50%) of pulmonary complications in the observation group, including 2 cases of pleural effusion and 1 case of pulmonary infection; There were 7 cases (28.00%) of pulmonary complications in the control group, including 4 cases of pleural effusion, 2 cases of pulmonary infection, and 1 case of atelectasis. After surgery, the observation group showed relief of pulmonary complications, while the control group had 2 cases of pleural effusion and 1 case of pulmonary infection.

Conclusion

Pulmonary rehabilitation training management can improve lung function, improve blood gas indicators, accelerate recovery speed, and reduce pulmonary complications in patients undergoing thoracoscopic esophagectomy.

Key words: Pulmonary rehabilitation training, Thoracoscopic laparoscopy, Post-esophagectomy, Pulmonary complications

Bingbing Gu, Wei Song, Boshi Fan, Ping Wang, Jing Ma, Jingwen Zhang, Na Zhou, Panpan Li. Clinical application of pulmonary rehabilitation management in postoperative pulmonary infection after minimally invasive esophagectomy[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(06): 949-954.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2025.06.016

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2025/V18/I06/949

Figures/Tables 4

References 31

1	温晓萌，孙彩萍，韩小云，等. 食管癌患者核心症状及症状群的网络分析[J]. 护理学杂志，2025, 40(5): 20-25.
2	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
3	徐睿锋, 王泓睿, 车云，等. 《癌症统计数据2025》解读：中美癌症流行病学特征及长期趋势对比研究[J]. 中国胸心血管外科临床杂志，2025, 32(4): 442-452.
4	Harada K, Rogers JE, Iwatsuki M, et al. Recent advances in treating oesophageal cancer[J]. F1000Res, 2020, 1(11): 9-13.
5	董翠萍，侯晓营，潜艳，等． "五联"预康复策略在高龄低肺功能食管癌术后病人护理中的应用效果观察[J]. 循证护理，2020, 6(3): 264-269.
6	孙雪梅，孙娜，黄卫东. 老年食管癌术后患者癌因性疲乏的研究进展[J]. 长春中医院大学学报，2019, 35(1): 193-196.
7	栾宇杰，施庆彤，包阳. 加速康复外科在食管癌手术治疗中的应用与进展[J]. 中国胸心血管外科临床杂志，2024, 31(3): 454-461.
8	Yang F, Li L, Mi Y, et al. Effectiveness of the tailored, early comprehensive rehabilitation program(tECRP) based on ERAS in improving the physical function recover for patients following minimally invasive esophagectomy：a prospective randomized controlled trial[J]. Support Care Cancer, 2022, 30(6): 5027-5036.
9	成钰娜，丁淳，杨洁，等. 护患及照顾者对食管癌围术期运动康复支持性照护体验的质性研究[J]. 护理学杂志，2023, 38(11): 92-96.
10	国家卫生健康委员会. 食管癌诊疗规范(2018年版)[J]. 中华消化病与影像杂志，2019, 9(4): 158-192.
11	孙曾锋，刘军强，范博士，等. 微创食管切除术联合三野或二野淋巴结清扫术治疗食管鳞状细胞癌257例近期疗效的回顾性队列研究[J]. 中国胸心血管外科临床杂志，2024, 31(4): 556-561.
12	岳彩迎，宋伟安，刘军强，等. 空肠穿刺造瘘术在食管癌外科治疗中的应用：258例分析[J]. 转化医学杂志，2020, 12(9): 360-362.
13	张干，任自学，张洪波，等. 高龄胸段食管鳞状细胞癌患者行McKeown治疗安全性及可行性分析[J]. 临床军医杂志，2023, 51(9): 960-964.
14	冯翠影，程刚，刘华，等. 并发症预警模式对老年肺癌免疫联合化疗患者免疫相关不良反应及T3、T4、TSH水平的影响[J]. 中国老年学杂志，2025, 45(10): 2330-2334.
15	Ajani JA, D’Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2.2023, NCCN clinical practice guidelines in onclolgy[J]. J Natl Compr Canc Netw, 2023, 21(4): 393-422.
16	焦曦，郭一璇，戴婷婷，等. 2024年食管癌治疗临床进展[J]. 肿瘤综合治疗电子杂志，2025, 11(2): 15-30.
17	鲁静，金慧玉，王振华，等. 快速康复外科在单孔胸腔镜肺癌围手术期的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2021, 14(2): 242-244.
18	潘国芬，李宁，郇梅，等. 路径式呼吸功能训练用于食管癌根治术后ERAS中的价值[J]. 中华保健医学杂志，2022, 24(6): 449-452.
19	金慧玉，王振华，朱荔，等. 目标锻炼结合多功能胸带用于食管癌围术期患者快速康复护理的效果[J]. 医学临床研究，2019, 36(10): 2066-2067.
20	吴琼，王萍，葛娇娇，等. 微创食管癌切除术围术期呼吸道管理对肺部感染的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(6): 995-998.
21	张冬蕾，魏华兵，周力璜，等. 快速康复外科联合胸腹腔镜下食管癌根治术对老年患者的疗效分析[J]. 上海交通大学学报(医学版), 2021, 41(1): 74-77.
22	郭舒婷，高建坤，林小菊. 呼吸功能训练对COPD缓解期患者肺功能和生活质量的影响[J]. 海南医学，2018, 29(6): 882-884.
23	李诗雨，邓颖. 振动排痰机联合综合性呼吸功能训练在老年食管癌患者术后康复中的应用效果分析[J]. 黑龙江医学，2022, 46(16): 1990-1996.
24	毛志蒙，孙云，汤平，等. 基于知信行理论的护理干预在食管癌根治术患者中的影响[J]. 护理实践与研究，2025, 22(3): 443-451.
25	姚花君. 振动式物理治疗仪联合个体化呼吸道护理对开胸术后肺部感染患者呼吸功能和睡眠质量的影响[J]. 医疗装备，2024, 37(5): 130-136.
26	洪宇彤，丘丽红，杨猛，等. 术前预康复策略在高龄食管癌手术患者中的应用效果[J]. 当代护士，2021, 28(29): 46-49.
27	高立红，曹娟，杨丹丹. 老年食管癌患者肺功能锻炼依从性对术后并发症以及生活质量的影响[J]. 老年医学与保健，2021, 27(6): 1205-1208.
28	Pecorelli N, Jr JFF, Gillis C, et al. The six-minute walk test as a measure of post operative recovery after colorectal resection：further examination of its measurement properties[J]. Surg Endoscopy, 2016, 30(6): 2199-2206.
29	于凤霞，于媛. 食管癌围手术期加速康复外科护理专家共识[J]. 护理学报，2024, 31(17): 61-66.
30	Wytske A, Mathieu H, Nick H, et al. A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients[J]. Respir Med, 2012, 106(5): 694-700.
31	Naz Ì，Şahin H, Aktaş B. Predictors of improvement in resting heart rate after exercise training in patients with chronic obstructive pulmonary disease[J]. Ir J Med Sci, 2022, 191(4): 1613-1619.

组　别	例数	FEV₁/FVC (%)		PEF(L/s)
组　别	例数	术前	术后	术前	术后
观察组	24	59.17±3.86	64.08±4.42	4.36±0.34	4.52±0.37
对照组	25	56.64±3.70	59.32±4.02	4.11±0.38	4.19±0.37
t值		2.342	4.761	2.502	3.200
P值		0.023	0.000	0.016	0.002

组　别	例数	FEV₁/FVC (%)		PEF(L/s)
组　别	例数	术前	术后	术前	术后
观察组	24	59.17±3.86	64.08±4.42	4.36±0.34	4.52±0.37
对照组	25	56.64±3.70	59.32±4.02	4.11±0.38	4.19±0.37
t值		2.342	4.761	2.502	3.200
P值		0.023	0.000	0.016	0.002

组　别	例数	PaO₂(mmHg)		PaCO₂(mmHg)		SaO₂(%)
组　别	例数	术前	术后	术前	术后	术前	术后
观察组	24	74.28±17.21	78.24±16.87	55.69±8.17	48.41±9.25	92.34±15.62	94.84±18.35
对照组	25	71.59±15.39	74.38±14.62	57.79±6.59	52.83±7.15	91.87±13.75	91.65±14.68
t值		0.577	0.857	－0.992	－1.876	0.112	0.673
P值		0.567	0.396	0.327	0.067	0.911	0.504

组　别	例数	PaO₂(mmHg)		PaCO₂(mmHg)		SaO₂(%)
组　别	例数	术前	术后	术前	术后	术前	术后
观察组	24	74.28±17.21	78.24±16.87	55.69±8.17	48.41±9.25	92.34±15.62	94.84±18.35
对照组	25	71.59±15.39	74.38±14.62	57.79±6.59	52.83±7.15	91.87±13.75	91.65±14.68
t值		0.577	0.857	－0.992	－1.876	0.112	0.673
P值		0.567	0.396	0.327	0.067	0.911	0.504

组　别	例数	频数(步/min)		呼吸(次/min)		心率(次/min)
组　别	例数	术前	术后	术前	术后	术前	术后
观察组	24	1 120.96±95.82	1 443.96±85.74	31.21±6.40	26.46±6.35	102.71±20.39	89.83±18.06
对照组	25	1 052.00±85.85	1 260.24±81.13	35.64±5.99	32.16±6.97	116.96±21.83	108.64±25.30
t值		2.810	8.143	－2.607	－3.098	－2.408	－3.059
P值		0.007	0.000	0.012	0.003	0.020	0.004

Please choose a citation manager

Content to export