基于WHO-FICs心肺运动试验在肺癌患者中应用的Scoping综述

doi:10.3969/j.issn.1006-9771.2021.08.007

Abstract

Abstract:

Objective To analyze the clinical application and main roles of Cardiopulmonary Exercise Test (CPET) in patients with lung cancer based on the theory of the World Health Organization Family International Classifications (WHO-FICs). Methods An evidence-based scoping review was implemented. Literatures related to the applications of CPET in patients with lung cancer were retrieved, from databases including PubMed, Web of Science, CNKI and Wanfang data; from January, 2013 to April, 2021. The indications, contraindications, motor dysfunction, pulmonary rehabilitation interventions, evaluation methods and indicators, and the environment factors of CPET applicated in patients with lung cancer was reviewed based on WHO-FICs framework. Results This paper analyzed the included literatures from five aspects: the type of disease, functioning, pulmonary rehabilitation exercise interventions, functioning evaluation and environment factors. The major diseases included different pathological types of non-small cell lung cancer (NSCLC) (2C25), and the most common complication of lung cancer was chronic obstructive pulmonary disease (COPD) (CA22). The obstacles of CPET conducted in lung cancer patients mainly included physical structure and functional activities and participation obstacles. Pulmonary rehabilitation based on the CPET was divided into therapeutic, preventive and health promotion interventions. The evaluation tools and indicators were oxygen intake, carbon dioxide output, oxygen pulse, heart rate, blood pressure, electrocardiogram, Borg Scale, 6-minute Walking Test, the MOS Item Short Form Health Survey (SF-36), etc. The classification and description of environmental factors were provided. Conclusion The application of CPET in lung cancer mainly included preoperative evaluation and prognosis prediction, exercise prescription formulation and exercise effect assessment, anti-cancer treatment impact assessment. Based on WHO-FICs theory system, the applications of CPET mainly involved NSCLC, and COPD was the most common complication of lung cancer. Pulmonary rehabilitation for lung cancer is function- and demand-oriented. Based on CPET evaluation results, individualized therapeutic, preventive and health promotion interventions are conducted to improve the overall function and optimize the health outcomes of patients with lung cancer.

Key words: cardiopulmonary exercise test, lung neoplasm, World Health Organization Family International Classifications, pulmonary rehabilitation, cardiorespiratory fitness, scoping review

WANG Dan,LI Jin,GAO Min,ZHANG Ming,CHEN Meng,ZHANG Yi-fan,XIA Lu-lu,CHEN Wei. Application of Cardiopulmonary Exercise Testing in Patients with Lung Cancer Based on World Health Organization Family International Classifications: A Scoping Review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(8): 923-935.

Figures/Tables 3

文献	国家	测试设备	测试方案	测试终点	测试作用	测试时间	研究设计
Yakal等^[16](2018)	土耳其	活动平板	改良Bruce方案	症状限制性	术前评估	肺切除术前	队列研究
Shafiek等^[18](2016)	西班牙	功率车	未描述	未描述	术前评估,预测预后	肺切除术前	观察性横断面研究(随访12个月)
Torchio等^[19](2017)	意大利	活动平板	Balke	症状限制性	术前评估	肺切除术前	回顾性研究
Edvardsen等^[22](2014)	挪威	活动平板	Bruce方案	症状限制性	评估术后高强度运动的效果	术前、术后4~6周(康复前)、康复训练后	RCT(单盲)
Bhatia等^[23](2019)	瑞士	功率车	Ramp	症状限制性	评估预康复运动处方效果	康复前、后	RCT
Egegaard等^[24](2019)	丹麦	功率车	Ramp	症状限制性	评估和训练	康复前、后	RCT(可行性研究)
Karenovics等^[25](2017)	瑞士	功率车	未描述	症状限制性	评估运动训练效果和训练	康复前、后及术后1年	RCT
Fresard等^[29](2016)	瑞士	功率车	Ramp	症状限制性	评估新辅助化疗影响	化疗前、后	横断面队列研究
Gravier等^[27](2019)	法国	功率车	Ramp	症状限制性	评估预康复效果	预康复前、后	回顾性队列研究
Perrotta等^[28](2019)	意大利	功率车	Ramp	达最大心率或症状限制	评估康复效果	康复训练前、后	回顾性研究
操敏等^[17](2013)	中国	功率车	Ramp	症状限制性	评估心肺功能特点	肺切除术前	病例对照研究
杨德松等^[20](2015)	中国	功率车	Ramp	症状限制性	术前评估,预测预后	肺切除术前	回顾性研究
夏露露等^[30](2020)	中国	功率车	Ramp	症状限制性	评估放疗对心肺运动功能的影响	放疗前、后	前瞻性队列研究
贺斌等^[26](2015)	中国	未描述	未描述	未描述	评估运动训练效果	入院时、运动训练后(术前1 d)	RCT
王俊义等^[21](2013)	中国	功率车	Ramp	症状限制性	探索CPET联合6MWT预测术后并发症	肺切除术前	病例对照研究

文献	疾病与标准	干预方法	评价指标与工具
Yakal等^[16](2018)	NSCLC (2C25); 拟手术肺癌患者		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、
Shafiek等^[18](2016)	肺癌(2C25)并发COPD(CA22); 肺功能FEV₁%或DLCO% < 40%		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740)
Torchio等^[19](2017)	肺癌(2C25); 术后预计FEV₁% < 30%或DLCO% < 30%患者进行CPET		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740)
Edvardsen等^[22](2014)	NSCLC (2C25),并发症包括COPD (CA22)、冠心病(L1-BA8)和糖尿病(L2-5A1); 年龄≤ 80岁,拟手术NSCLC患者	治疗类跑台训练(93.22001) 呼吸训练(93.18002) 肌肉功能训练(MU2.PH.ZZ)	身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740) 活动和参与座椅站立试验、15 s最大登楼台阶测试、60 s单腿静态平衡改良试验环境运动测试和(或)运动训练场所综合评估工具 SF-36、EORTC-QOL-C30 环境卫生专业人员(e355)
Bhatia等^[23](2019)	NSCLC (2C25); 临床分期Ⅰ~3A	预防类关节活动功能训练(MTB.PH.ZZ) 肌肉功能训练(MU2.PH.ZZ) 肌肉耐力有关的运动(MUD.PG.ZZ) 功率自行车训练(93.81001)	身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740)、情感功能(b152) 活动和参与 6MWT(d450) IPAQ-L 环境卫生专业人员(e355) 综合评估工具 FACT-L
Egegaard等^[24](2019)	NSCLC (2C25); 拟行同期放、化疗(⁶⁶Gy,33次),> 18岁,WHO功能分级0~1	健康促进类功率自行车训练(93.81001)	身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740) 活动和参与 6MWT(d450) 环境卫生专业人员(e355)
Karenovics等^[25](2017)	肺癌(2C25),并发症包括COPD (CA22)、高血压(L1-BA0)、糖尿病(L2-5A1)、冠心病(L1-BA8)、脑卒中(8B11)		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740) 环境卫生专业人员(e355)
Fresard等^[29](2016)	NSCLC(2C25),并发症包括冠心病(L1-BA8)、高血压(L1-BA0)、COPD(CA22)、抑郁症(6E62.0); >18岁		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740)
Gravier等^[27](2019)	NSCLC(2C25); >18岁	健康促进类功率自行车训练(93.81001) 跑台训练(93.22001) 肌肉功能训练(MU2.PH.ZZ) 呼吸训练(93.18002)	身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740) 环境术后住院时间(e199、e355) 运动测试和(或)运动训练场所
Perrotta等^[28](2019)	NSCLC(2C25)并发COPD(CA22); 临床分期Ⅰ~ⅢA拟手术患者,< 80岁,BMI 18~34 kg/m²,符合COPD诊断标准	预防类关节活动功能训练(MTB.PH.ZZ) 肌肉功能训练(MU2.PH.ZZ) 肌肉耐力有关的运动(MUD.PG.ZZ) 功率自行车训练(93.81001)	身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740) 环境卫生专业人员(e355)
操敏等^[17](2013)	肺癌(2C25); 肺通气功能正常,既往无神经肌肉疾患、无胸腔/心包积液,无风心病、先心病等心脏病史		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740)
杨德松等^[20](2015)	肺癌(2C25); 所有患者均接受肺切除术		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740)
夏露露等^[30](2020)	肺癌(2C25),并发症包括高血压(L1-BA0)、糖尿病(L2-5A1); 年龄40~75岁,首次接受放疗,卡氏评分> 80,神志清晰、病情稳定且能配合检查		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740)、情感功能(b152) 综合评定工具 SF-36
贺斌等^[26](2015)	肺癌(2C25)并发COPD(CA22); 肺功能确诊COPD,病理检查确诊肺癌且具备手术指征,无严重器质性损害和急性并发症,无运动训练禁忌证	预防类关节活动功能训练(MTB.PH.ZZ) 肌肉功能训练(MU2.PH.ZZ) 肌肉耐力有关的运动(MUD.PG.ZZ) 功率自行车训练(93.81001)	身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740)、疼痛评分(b280)、情感功能(b152) 活动和参与 6MWT(d450) 环境术后住院时间(e199、e355) 卫生专业人员(e355) 用品和技术中(e1)中的药品(e1101)、其他特指的用品和技术(e198)支持
王俊义等^[21](2013)	肺癌(2C25)		身体结构和功能心脏功能(b410)、血压功能(b420)、血液系统功能(b430)、呼吸系统功能(b440)、一般代谢功能(b540)、肌肉耐力功能(b740) 活动和参与 6MWT(d450)

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文献	禁忌证	身体结构与功能
Egegaard等^[24](2019)	舒张压< 45 mmHg或> 95 mmHg	心血管系统功能 b420血压功能 b410心脏功能
Bhatia等^[23](2019)	静息心率> 115 bpm
Fresard等^[29](2016)	未控制的心脏病
Fresard等^[29](2016)	严重肺动脉高压	心血管系统的结构 s4100心脏 s4101动脉
Egegaard等^[24](2019)	静息呼吸频率≥ 30次/min 严重的胸闷气短未控制的哮喘	呼吸系统功能 b440呼吸功能 b460与心血管和呼吸功能相关的感觉
Fresard等^[29](2016)	关节、肌肉相关功能受限	神经肌肉骨骼和运动有关的功能 b710关节活动功能 b730肌肉力量功能 b740肌肉耐力功能
Edvardsen等^[22](2014)	关节相关功能受限
Bhatia等^[23] (2019)	无法踏车或在平板上运动
Fresard等^[29](2016)	精神疾病	精神功能 b110意识功能 b117智力功能 b164高水平认知功能 b167语言精神功能
Perrotta等^[28](2019)	认知障碍
Edvardsen等^[22](2014)	语言障碍
Egegaard等^[24](2019)	体温> 38 ℃	其他 b550温度调节功能 b435免疫系统功能
Egegaard等^[24](2019)	需要治疗的感染	其他 b550温度调节功能 b435免疫系统功能

Application of Cardiopulmonary Exercise Testing in Patients with Lung Cancer Based on World Health Organization Family International Classifications: A Scoping Review

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