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夏露露,高 民,李 瑾,张 明,殷海涛,陈 猛,陈 伟.心肺运动试验评估肺癌患者放射治疗前后整体功能变化的临床研究[J].中国康复医学杂志,2020,(7):830~836
心肺运动试验评估肺癌患者放射治疗前后整体功能变化的临床研究    点此下载全文
夏露露  高 民  李 瑾  张 明  殷海涛  陈 猛  陈 伟
江苏省青年医学人才基金(QNRC2016376)
;徐州市医学青年后备人才工程资助(2016015)
;徐州市科技计划项目(KC18184)
基金项目:江苏省青年医学人才基金(QNRC2016376);徐州市医学青年后备人才工程资助(2016015);徐州市科技计划项目(KC18184)
DOI:10.3969/j.issn.1001-1242.2020.07.012
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摘要:
      摘要 目的:探讨心肺运动试验(cardiopulmonary exercise testing,CPET)对肺癌患者放射治疗前后整体功能的评估作用。 方法:选择2017—2018年在徐州市中心医院住院拟行放疗的肺癌患者12例为研究对象,于放疗前一天和放疗结束后1周均进行症状限制性CPET及静态肺功能一体化检查,通过对数据标准化分析计算其核心指标,并从系统软件导出静息状态、热身状态、无氧阈状态、极限状态及恢复状态时的循环指标、呼吸指标及静态肺功能检查指标;通过SF-36、SAS和SDS量表评估患者放疗前后的生存质量、焦虑及抑郁情况。 结果:患者放疗后峰值摄氧量、峰值负荷功率和递增功率运动时间较放疗前明显降低,二氧化碳通气当量斜率及二氧化碳通气当量最低值较放疗前显著升高,均有显著性差异(P<0.05);无氧阈、峰值氧脉搏、摄氧量与功率比值、呼吸储备及代谢当量等值与放疗前比较,差异均无显著性意义(P>0.05)。患者放疗后静息状态下的心率和极限状态、恢复状态下的二氧化碳通气当量较放疗前显著升高(P<0.05);氧脉搏在各个阶段变化不显著(P>0.05)。静息、热身、无氧、极限以及恢复各个状态下的潮气末二氧化碳分压较放疗前明显降低,热身和恢复状态下的氧通气当量显著升高,差异均有显著性意义(P<0.05);潮气末氧分压、呼吸储备,以及呼吸无效腔与潮气量的比值在各个阶段变化不显著(P>0.05)。静态肺功能中,分钟通气量、肺活量、用力肺活量、第1秒用力呼气量、1秒用力呼气量占用力肺活量的百分比、最大呼气中段流速及最大通气量等指标较放疗前无显著变化(P>0.05)。SF-36量表八个维度得分在放疗后均有不同程度的减少,放疗前、后生理职能得分始终较低,无显著性差异(P>0.05);生理机能、躯体疼痛、一般健康状况、精力、社会功能、情感职能和精神健康等维度得分较放疗前显著减少(P<0.05);焦虑量表得分较放疗前显著升高(P<0.05),抑郁量表得分较放疗前升高,差异无显著性意义(P>0.05)。 结论:肺癌患者放疗后会出现整体功能的下降,主要是影响循环和细胞代谢功能,呼吸处于相对代偿状态;CPET可用于患者放疗前后整体功能的评估。
关键词:肺癌  放疗  放射性肺损伤  心肺运动试验  整体功能
The role of cardiopulmonary exercise testing in the evaluation of the changes of holistic function of patients with lung cancer after radiotherapy    Download Fulltext
Xuzhou Medical University,Xuzhou,221004
Fund Project:
Abstract:
      Abstract Objective:To investigate the role of cardiopulmonary exercise testing(CPET)in the evaluation of the changes of holistic function of patients with lung cancer after radiotherapy. Method:From 2017 to 2018,12 patients with lung cancer admitted to Xuzhou Central Hospital for radiotherapy were enrolled. Symptom-limited CPET and static pulmonary function examinations were taken one day before and one week after radiotherapy. The circulation indexes, respiration indexes and static pulmonary function indexes in quiescent state, warm-up state,anaerobic threshold(AT)state, extreme state and recovery state were derived by system software,. Quality of life, anxiety and depression were assessed by SF-36, SAS and SDS scales before and after radiotherapy. Result:After radiotherapy, peak oxygen uptake, peak load power and incremental power exercise time were significantly lower than those before radiotherapy, while the slope of carbon dioxide ventilation equivalent and the lowest value of carbon dioxide ventilation equivalent were significantly higher than those before radiotherapy(P<0.05). Anaerobic threshold,peak oxygen pulse, oxygen uptake to power ratio, respiratory reserve and metabolic equivalent were not significantly different from those before radiotherapy(P>0.05). Heart rate in a quiescent state and carbon dioxide ventilation equivalent in extreme state and recovery state were significantly higher after radiotherapy than before(P<0.05). Oxygen pulse did not change significantly at all stages(P>0.05).The partial pressures of end-tidal carbon dioxide in the five states were significantly lower than those before radiotherapy, and the oxygen ventilation equivalent in a warm-up state and recovery state was significantly higher(P<0.05). Partial pressure of oxygen at the end of tidal phase, breathing reserve and the ratio of invalid breathing chamber to tidal volume did not change significantly in all stages(P>0.05). In static lung function, minute ventilation volume, vital capacity, forced vital capacity, forced expiratory volume in first second, percentage of forced expiratory volume occupied by forced expiratory volume,maximum expiratory flow rate and maximum ventilation volume had no significant changes compared with those before radiotherapy(P>0.05).The scores of the eight dimensions of the SF-36 scale decreased after radiotherapy,the scores of role-physical before and after radiotherapy were always low,with no statistical difference(P>0.05).The scores of physical functioning,bodily pain,general health,vitality,social functioning,role-emotional and mental health were significantly lower than those before radiotherapy(P<0.05).The score of anxiety scale was significantly higher than that before radiotherapy(P<0.05).The score of depression scale was higher than that before radiotherapy,but no significant difference(P>0.05). Conclusion:After radiotherapy, the holistic function of patients with lung cancer decreased, mainly in circulation and cell metabolism, and the respiration is in a relative compensatory state. CPET could be used in evaluating the holistic function of cancer patients before and after radiotherapy.
Keywords:lung cancer  radiotherapy  radiation-induced lung injury  cardiopulmonary exercise testing  the holistic function
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