Abstract:

Objective To evaluate the application effect of nurse-led early pulmonary rehabilitation strategies in elderly patients after lung cancer surgery，and provide an evidence-based basis for optimizing the rehabilitation nursing plan for elderly patients after lung cancer surgery. Methods A randomized controlled trial design was adopted. Patients were recruited from the thoracic surgery department of a tertiary A tumor specialized hospital in Tianjin from September 2024 to March 2025，strictly according to the inclusion and exclusion criteria. Patients were divided into an experimental group（70 patients） and a control group（70 patients） using block randomization. The experimental group received nurse-led early pulmonary rehabilitation strategies，while the control group received conventional pulmonary rehabilitation nursing. After the intervention，the differences in pulmonary infection，forced vital capacity，6-minute walk distance，blood oxygen saturation，postoperative hospital stay，pain score，exercise self-efficacy，and pulmonary air leakage were compared between the 2 groups. Results Finally，62 patients in the experimental group and 68 patients in the control group completed the study. After the intervention，the 6-minute walk distance of the experimental group was（363.76±54.42） m，which was higher than（336.01±55.56） m in the control group；the forced vital capacity was（1.58±0.47） L，higher than（1.28±0.33） L in the control group；the exercise self-efficacy score was（56.9±12.2） points，higher than（43.0±13.0） points in the control group；repeated-measures ANOVA showed that there was an interaction effect between time and group for postoperative blood oxygen saturation and pain scores in both groups（P<0.05）. Simple effect analysis showed that the pain score of the experimental group on the third day was（1.97±0.51） points，lower than（2.20±0.55） points in the control group；the pain score on the first day after surgery and blood oxygen saturation on the 2nd to 3rd days after surgery were higher than those in the control group，and the differences were statistically significant（P<0.05）. There was no significant difference in the duration of postoperative lung infection，postoperative hospital stay，duration of lung leakage，and incidence of persistent lung leakage between the 2 groups（P>0.05）. Conclusion The nurse-led early pulmonary rehabilitation strategies are beneficial to promote postoperative pulmonary recovery，improve patients’ activity endurance，enhance oxygenation，and boost patients’ confidence in completing subsequent pulmonary rehabili-tation training.

Key words: Aged, Lung Cancer, Enhanced Recovery After Surgery, Pulmonary Rehabilitation, Rehabilitation Nursing

摘要：

目的 评价护士主导的早期肺康复策略在老年肺癌术后患者中的应用效果，为优化老年肺癌术后康复护理方案提供循证依据。方法 采用随机对照试验研究设计，按照纳入、排除标准，于2024年9月至2025年3月在天津市某三级甲等肿瘤专科医院胸外科招募患者，采用区组随机化分为试验组70例和对照组70例，试验组采用护士主导的早期肺康复策略，对照组采用常规肺康复护理。比较两组干预前后肺部感染发生率、用力肺活量、6 min步行距离、血氧饱和度、术后住院时间、疼痛评分、运动自我效能和肺漏气情况的差异。结果 最终试验组62例、对照组68例完成研究。干预后，试验组6 min步行距离为（363.76±54.42）m，高于对照组的（336.01±55.56）m；用力肺活量为（1.58±0.47）L，高于对照组的（1.28±0.33）L；运动自我效能评分为（56.9±12.2）分，高于对照组的（43.0±13.0）分。重复测量方差分析显示，两组术后血氧饱和度和疼痛评分均存在时间与组间的交互效应（P<0.05）。简单效应分析显示，试验组术后第3天疼痛评分（1.97±0.51）分，低于对照组的（2.20±0.55）分；术后第1天疼痛评分、术后第2~3天血氧饱和度高于对照组，差异均具有统计学意义（P<0.05）。两组术后肺部感染发生率、术后住院时间、肺漏气持续时间、持续性肺漏气发生率比较，差异无统计学意义（P>0.05）。结论 护士主导的早期精细化肺康复策略可促进肺癌患者术后肺功能恢复，增强活动耐力，改善氧合，提升患者后续完成肺康复训练的信念。

关键词: 老年人, 肺癌, 加速康复外科, 肺康复, 康复护理