Povezanost respiratorne rehabilitacije sa uspehom hirurškog lečenja bolesnika sa hroničnom opstrukcijskom bolesti i primarnim karcinomom pluća

Abstract

Tokom poslednjih 10 godina, funkcionalna procena prehirurškog lečenja karcinoma pluća značajno se izmenila. Ne samo da su se izmenile granične vrednosti parametara ventilacije u pogledu bezbedne resekcije, već su i visoko sofisticirani metodi predvidjanja postoperativne plućne funkcije i procena operativnog rizika postali rutinski postupak Osim toga, samo životno doba više ne predstavlja kontraindikaciju za hirurško lečenje, pa je sve više starijih osoba koje nakon prePR imaju mogućnost hiruškog lečenja. Uticaj fizikalne terapije na ishod resekcije pluća je još uvek kontroverzan. Kako se fizikalna terapija danas rutinski koristi kod većine kandidata za hirurško lečenje, bez obzira na njihovu spremnost za hirurško lečenje, teško je posebno analizirati specifičan doprinos ovog tretmana ishodu hirurškog lečenja. Cilj Cilj ovog ispitivanja je procena doprinosa fizikalne terapije postoperativnoj plućnoj funkciji i podnošenju napora kod pacijenata sa HOBP podvrgnutih hirurškom lečenju karcinoma pluća, a na osnovu poredjenja preoperativnog testiranja respiratorne funkcije i podnošenja napora pre i posle fizikalne terapije pomoću istih testova sprovedenih postoperativno, kao i uporedjivanje ovih pacijenata sa grupom pacijenata sa HOBP bez preoperativne fizikalne terapije. Materijal i metod Istraživanjem je obuhvaćeno ukupno 180 konsekutivnih bolesnika koji su ispitivani, lečeni i operisani od strane istog lekarskog tima i prema istim protokolima. Svi bolesnici su imali primarni karcinom pluća. Ove bolesnike smo podelili u dve grupe: jednu grupu su činili bolesnici sa HOBP,( n=130), a dugu grupu bolesnici koji nisu imali HOBP, (n=50). Grupu bolesnika koji su imali HOBP podelili smo na dve podgrupe, na osnovu toga da li su imali preoperativnu plućnu rehabilitaciju(PPR) ili nisu imali PPR. Jedna podgrupa bolesnika, ( n=83), imali su u preoperativnim periodu doziranu i kontrolisanu preoperaivnu plućnu rehabilitaciju (PPR) i druga podgrupa bolesnika, (n=47), nisu imali PPR. Drugu grupu bolesnika koji nisu imali HOBP, takodje smo podelili u dve podgrupe, jednu podgrupu koja je imala PPR, (n=30), i drugu podgrupu ( n=20), koja nije imala PPR. Rezultati Kod pacijenata sa karcinomom pluća gde je bilo potrebno načiniti lobektomiju, posle preoperativne fizikalne terapije, registrovano je visoko signifikantno povećanje FEV1, VC, FEF50 i FEF25 prema početnim vrednostima. Posle fizikalne terapije ostvareno je signifikantno poboljšanje u odnosu na pređeno rastojanje u toku 6MWD. Nakon resekcije pluća, došlo je do značajnog smanjenja FEV1 i VC uz značajno pogoršanje funkcije malih disajnih puteva, podnošenja napora i postojeće simptomatologije. Nakon hirurškog zahvata, postojala je jasna tendencija manjem smanjenju FEV1 kod pacijenata sa umerenim do teškim oštećenjem plućne funkcije u poredjenju sa pacijentima sa blagim početnim oštećenjem. Veće poboljšanje FEV1 bilo je udruženo sa značajnijim smanjenjem FEV1 Zaključak Dobijni rezultati potvrdjuju da plućna rehabilitacija predstavlja važan deo preoperativnog i postoperativnog lečenja kod bolesnika sa HOBP koji su podvrgnuti resekciji pluća zbog karcinoma pluća.

Over the past 10 years, functional assessment before surgical treatment of lung cancer has changed significantly. Not only have they changed the limits for ventilation parameters in terms of safe resection, but also a highly sophisticated method of prediction of postoperative lung function and operational risk assessments have become routine Furthermore, only age is no longer a contraindication for surgery, and more older people who have the ability obstacle after surgical treatment. The impact of physical therapy on the outcome of lung resection is still controversial. How can physical therapy now used routinely by most candidates for surgery, regardless of their readiness for surgery is particularly difficult to analyze the specific contribution of the treatment outcome of surgical treatment. Goal The aim of this study was to assess the contribution of physical therapy postoperative pulmonary function and exercise tolerance in patients with COPD who underwent surgical treatment of lung cancer, based on comparisons of preoperative respiratory function tests and exercise tolerance before and after physical therapy using the same tests conducted after the surgery, as well as comparison of these patients with a group of patients without preoperative saHOBP physical therapy. Materials and Methods The study included a total of 180 consecutive patients who were tested, treated and operated on by the same medical team and the same protocols. All patients had primary lung cancer. These patients were divided into two groups: one group consisted of patients with COPD, n = 130, a long group patients who did not have COPD, n = 50 Group of patients who had COPD were divided into two subgroups on the basis of whether they had preoperative pulmonary rehabilitation (PPR) or had no PPR. One subgroup of patients, n = 83, had been in the preoperative period dosed and controlled preoperaivnu pulmonary rehabilitation (PPR) and other groups of patients, n = 47, had no PPR. The second group of patients who did not have COPD, also were divided into two subgroups, one subgroup that had a PPR, n = 30, and the other subgroup n = 20, which had no PPR. Results In patients with tumors where it was necessary to make a lobectomy after preoperative physical therapy, registered a highly significant increase in FEV1, VC, FEF50 and FEF25 the initial values. After physical therapy achieved a significant improvement compared to the distance covered during the 6MWD. After lung resection, there was a significant reduction in FEV1 and VC with a significant worsening of the small airways function, exercise tolerance and current symptomatology. After surgery, there was a clear tendency for a smaller reduction of FEV1 in patients with moderate to severe impairment of lung function compared with patients with mild initial impairment. Higher increase in FEV1 was associated with a significant reduction in FEV1 Conclusion Our result confirms that pulmonary rehabilitation is an important part of the preoperative and postoperative treatment in patients with COPD who underwent lung resection for lung cancer.