关键词: 老年人；肺肿瘤；运动处方；康复护理；围手术期；加速康复外科

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 tertiary-level 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.

Key words: elderly; lung neoplasm; exercise prescription; rehabilitation nursing; perioperative; Enhanced Recovery After Surgery