【摘要】 目的 ：制定老年肺癌胸腔镜手术患者围手术期运动处方并评价实施效果，以期促进老年肺癌手术患者早期康复。方法 ：系统检索2015年1月1日至2021年4月30日国内外有关围手术期运动处方相关的指南、专家共识、证据总结等，筛选并制定了老年肺癌胸腔镜手术患者围手术期运动处方，并于2021年5月至2022年5月便利选取天津市某三级甲等肿瘤医院2个外科拟行肺切除术的289例老年肺癌患者为研究对象，分为对照组（n=177例）与观察组（n=112例）。采用非随机同期对照，对照组患者采用常规护理；观察组患者于术前7日，术后至出院实施运动处方，包括阈值吸气肌训练、抗阻训练、耐力训练。比较2组患者术后的肺感染率、住院天数，术后第1日24 h胸腔引流量，术后第1日晨白细胞计数、C-反应蛋白水平、前白蛋白水平，术后3日的最低经皮血氧饱和度，纤维支气管镜吸痰率，因气道因素转入ICU率，运动自我效能等指标。结果 ：观察组术后肺感染率、术后第1日晨白细胞计数、纤维支气管镜吸痰率、因气道因素转入ICU率低于对照组；术后第1日24 h胸腔引流量、术后3日的最低经皮血氧饱和度、术后第1日前白蛋白水平、出院前运动自我效能评分高于对照组，两组差异具有统计学意义(P<0.05)。结论 ：围手术期的运动处方可有效改善老年肺癌患者术后临床结局，提升运动的自我效能。更多还原

【Abstract】 Objective: To design a perioperative exercise prescription for elderly patients undergoing thoracoscopic surgery for lung cancer and evaluate the implementation effect, aiming at promoting early recovery after surgery.Methods: Domestic and foreign guidelines, expert consensus, evidence summaries were systematically searched related to perioperative exercise prescription from January 1, 2015 to April 30, 2021, and we screened and formulated the perioperative exercise prescription for elderly patients undergoing thoracoscopic surgery for lung cancer. Totally 289 elderly lung cancer patients were conveniently selected who were scheduled to undergo pneumonectomy in 2 thoracic departments of a tertiarylevel cancer hospital in Tianjin from May 2021 to May 2022. This study was a non-randomized contemporaneous controlled experiment in which patients were divided into the control group(n=177) and the observation group(n=112). Patients in the control group received routine nursing, while those in the observation group were given the nurse-led perioperative exercise prescriptions regarding inspiratory muscle training, resistance training and endurance training. We compared the postoperative lung infection rate(grade I to V), the chest drain volume on the first 24h after surgery, the duration of hospitalization, the white blood cell(WBC) count, the C-reactive protein(CRP) value and the prealbumin(PALB) value on the first morning after surgery, the lowest pulse oxygen saturation(SpO2) within three days after surgery, the frequency of suction with fiberoptic bronchoscope, the number of cases transferred to ICU due to airway factors, and patients’ self-efficacy for exercise of the two groups. Results: The rate of lung infection, the WBC count, the frequency of suction with fiberoptic bronchoscope, and the number of cases transferred to ICU due to airway factors were lower in the observation group than those in the control group. The lowest SpO2, chest drainage at 24 hours after surgery, the PALB value, and self-efficacy for exercise before discharge of observation group were higher than those in the control group, and the differences between the two groups were statistically significant(P<0.05). Conclusion: Perioperative exercise prescriptions can effectively improve the clinical outcomes of elderly patients with lung cancer after surgery, and boost their self-efficacy for exercise.更多还原