Journal of Advances in Clinical Nursing
Journal of Advances in Clinical Nursing. 2026; 5: (3) ; 10.12208/j.jacn.20260115 .
总浏览量: 38
复旦大学附属肿瘤医院护理部，复旦大学上海医学院肿瘤学系 上海
*通讯作者： 张莉萍,单位：复旦大学附属肿瘤医院护理部，复旦大学上海医学院肿瘤学系 上海；
目的 探讨基于循证的围手术期呼吸训练管理方案在肺癌手术患者中的应用效果。方法 以持续质量改进模式为理论框架，选取2023年8-10月我院胸外科就诊的肺癌手术治疗102例患者作为持续质量改进前组，采用常规护理模式；选取2024年5-7月我院胸外科就诊的肺癌手术治疗100例患者作为持续质量改进后组，采用基于循证的围手术期呼吸训练管理方案，比较实施前后患者呼吸训练审查指标执行率，胸腔引流管留置时间及术后住院时间。结果 围手术期呼吸训练管理方案包括评估与准备、呼吸训练策略和多模式合作策略三大方面，共11项执行指标。方案实施后，各项指标执行率均提高；肺癌患者胸腔引流管留置时间为（49.44±26.92）h， 显著低于实施前的（65.43±50.41）h，差异具有显著统计学意义（P＜0.01）；患者术后住院时间为（3.38±1.31）天，低于实施前的（3.92±1.90）天，两者具有统计学差异（P＜0.05）。结论 基于循证方法学的肺癌手术患者呼吸训练管理方案能有效促进临床持续质量改进，同时显著缩短术后胸腔引流管留置时间及住院时间，有效推进临床ERAS的顺利开展，为临床护理提供理论参考。
Objective To explore the application effect of an evidence-based perioperative respiratory training management program in lung cancer surgery patients. Methods Using the continuous quality improvement model as a theoretical framework, 102 lung cancer surgery patients who underwent surgery in the Department of Thoracic Surgery of our hospital from August to October 2023 were selected as the pre-continuous quality improvement group and received routine nursing care. 100 lung cancer surgery patients who underwent surgery in the Department of Thoracic Surgery of our hospital from May to July 2024 were selected as the post-continuous quality improvement group and received an evidence-based perioperative respiratory training management program. The implementation rate of respiratory training review indicators, the duration of chest drainage tube placement, and the postoperative hospital stay were compared before and after implementation. Results The perioperative respiratory training management program included three main aspects: assessment and preparation, respiratory training strategies, and multimodal collaboration strategies, with a total of 11 implementation indicators. After implementation, the execution rates of all indicators improved. The indwelling time of the chest drainage tube in lung cancer patients was (49.44±26.92) h, significantly lower than (65.43±50.41) h before implementation, with a statistically significant difference (P<0.01). The postoperative hospital stay was (3.38±1.31) days, lower than (3.92±1.90) days before implementation, with a statistically significant difference (P<0.05). Conclusion The evidence-based respiratory training management program for lung cancer surgical patients can effectively promote continuous clinical quality improvement, significantly shorten the indwelling time of the chest drainage tube and the length of hospital stay, effectively promote the smooth implementation of clinical ERAS, and provide a theoretical reference for clinical nursing.
[1] 肖佳龙, 郑莹. 全球肺癌的流行及预防进展[J]. 中国癌症杂志, 2020,30(10):721-725.
[2] 钟润波, 王奕洋, 韩宝惠, 等. 《中华医学会肺癌临床诊疗指南（2022版）》解读[J]. 中国胸心血管外科临床杂志, 2022,29(11):1402-1406.
[3] 王天佑, 李单青, 崔永, 等. 胸外科围手术期肺保护中国专家共识（2019版）[J]. 中国胸心血管外科临床杂志, 2019,26(09):835-842.
[4] Codima A, Das N S W, de Souza B A, et al. Exercise prescription for symptoms and quality of life improvements in lung cancer patients: a systematic review[J]. Support Care Cancer, 2021,29(1):445-457.
[5] de Oliveira Vacchi C, Martha B A, Macagnan F E. Effect of inspiratory muscle training associated or not to physical rehabilitation in preoperative anatomic pulmonary resection: a systematic review and meta-analysis[J]. Supportive Care in Cancer, 2022,30(2):1079-1092.
[6] Gravier F E, Smondack P, Prieur G, et al. Effects of exercise training in people with non-small cell lung cancer before lung resection: a systematic review and meta-analysis[J]. Thorax, 2021,0:1-11.
[7] Henshall C L, Allin L, Aveyard H. A Systematic Review and Narrative Synthesis to Explore the Effectiveness of Exercise-Based Interventions in Improving Fatigue, Dyspnea, and Depression in Lung Cancer Survivors[J]. Cancer Nurs, 2019,42(4):295-306.
[8] Kendall F, Oliveira J, Peleteiro B, et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis[J]. Disability and rehabilitation, 2018,40(8):864-882.
[9] Pu C Y, Batarseh H, Zafron M L, et al. Effects of Preoperative Breathing Exercise on Postoperative Outcomes for Patients With Lung Cancer Undergoing Curative Intent Lung Resection: A Meta-analysis[J]. Arch Phys Med Rehabil, 2021,102(12):2416-2427.
[10] Wang Y Q, Liu X, Jia Y, et al. Impact of breathing exercises in subjects with lung cancer undergoing surgical resection: A systematic review and meta‐analysis[J]. Journal of Clinical Nursing, 2018,28(5-6):717-732.
[11] 邢唯杰, 胡雁, 周英凤, 等. 推动证据向临床转化(四)以临床转化为目的的证据资源检索[J]. 护士进修杂志, 2020,35(10):879-882.
[12] 曹靓, 张婷婷, 张晓菊, 等. 肺癌患者围手术期呼吸物理治疗策略的最佳证据总结[J]. 护士进修杂志, 2023, 38(14):1309-1314.
[13] Batchelor T, Rasburn N J, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)[J]. Eur J Cardiothorac Surg, 2019,55(1):91-115.
[14] 支修益, 刘伦旭. 中国胸外科围手术期气道管理指南（2020版）[J]. 中国胸心血管外科临床杂志, 2021, 28(03):251-262.
[15] Gao S, Barello S, Chen L, et al. Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery[J]. Translational Lung Cancer Research, 2019,8(6):1174-1187.
[16] Berna P, Quesnel C, Assouad J, et al. Guidelines on enhanced recovery after pulmonary lobectomy[J]. Anaesthesia Critical Care & Pain Medicine, 2021,40(1): 100791.
[17] 车国卫, 吴齐飞, 邱源, 等. 多学科围手术期气道管理中国专家共识(2018版)[J]. 中国胸心血管外科临床杂志, 2018,25(07):545-549.
[18] Odhiambo M. Evidence Summary. Postoperative Pulmonary Complications: Postoperative Strategies[J]. The JBI EBP Database, 2022,JBI-ES-2282-2.
[19] El-Sayed Ahmed R. Evidence Summary. Post-operative Chest Physiotherapy: Incentive Spirometry (Trifow)[J]. The JBI EBP Database, 2021,JBI-ES-2633-2.
[20] 殷静静, 吕芳芳, 杨丽娟. 肺癌患者术前呼吸训练管理的最佳证据总结[J]. 中华现代护理杂志, 2020,26(9): 1166-1170.
[21] 阮亮, 张国龙, 曾秋璇, 等. 呼吸功能训练器对胸外科术后病人肺康复的影响[J]. 护理研究, 2022,36(22): 4085-4087.
[22] Ahmad A M. Essentials of Physiotherapy after Thoracic Surgery: What Physiotherapists Need to Know. A Narrative Review[J]. The Korean Journal of Thoracic and Cardiovascular Surgery, 2018,51(5):293-307.
[23] 宋猛. 围手术期呼吸道管理对肺癌手术治疗患者术后Borg评分及肺功能的影响[J]. 现代医学与健康研究电子杂志, 2022,6(23):83-85.