摘要
目的观察非通气侧肺持续中低流量给氧在老年患者胸腔镜肺癌根治术后的应用效果及其对患者肺部并发症(PPC)的影响。方法选择择期行胸腔镜下肺癌根治术的老年患者100例,随机分为观察组和对照组,每组50例。观察组术中在单肺通气(OLV)后非通气侧肺给予1~4 L/min的氧气通入,对照组不予特殊处理。比较两组手术时间、麻醉时间、单肺通气时间、术中失血量、呼吸恢复时间、苏醒时间、气管导管拔除时间及OLV时的术者满意度,麻醉诱导后即刻(T_(0))和OLV后30 min(T_(1))、1 h(T_(2))、2 h(T_(3))的动脉血氧分压(PaO_(2))和动脉血二氧化碳分压(Pa‐CO_(2)),术前及术后1、3 d的白细胞计数、中性粒细胞计数和中性粒细胞百分比,术后PPC及不良反应发生情况,术后1、2 d的15项恢复质量量表(QoR-15)评分,麻醉后监测治疗室(PACU)停留时间和住院时间。结果两组手术时间、麻醉时间、单肺通气时间、术中失血量、呼吸恢复时间、苏醒时间、气管导管拔除时间及OLV时的术者满意度比较均无统计学差异(P均>0.05)。与同组T_(0)时间点比较,两组T_(1)~T_(3)时间点PaO_(2)均下降、PaCO_(2)均升高,且对照组变化更明显(P均<0.05)。与同组术前比较,两组术后1、3 d的白细胞计数、中性粒细胞计数和中性粒细胞百分比均升高,且对照组升高更明显(P均<0.05)。观察组术后PPC总发生率为14%(7/50),对照组为34%(17/50),两组比较P<0.05。两组术后各不良反应发生率比较P均>0.05。观察组术后PACU停留时间和住院时间均短于对照组,术后1、2 d QoR-15评分均高于对照组(P均<0.05)。结论老年患者胸腔镜肺癌根治术中给予非通气侧肺持续中低流量给氧有助于改善氧合功能、抑制术后炎症反应、减少PPC发生、促进术后康复,且安全性较高。
Objective To evaluate the application effect of continuous medium and low flow oxygen supply to nonventilated lung in elderly patients with thoracoscopic radical surgery for lung cancer and its effect on the postoperative pulmonary complications(PPC).Methods A total of 100 elderly patients undergoing elective thoracoscopic radical resection of lung cancer were selected and randomly divided into the observation group and control group,with 50 cases in each group.In the observation group,1-4 L/min of oxygen was given to the non-ventilated side lung after one-lung ventilation(OLV),while patients in the control group received no special treatment.The operation time,anesthesia time,one-lung ventilation time,intraoperative blood loss,respiratory recovery time,wake-up time,tracheal intubation time,operator satisfaction during OLV,and arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(Pa‐CO_(2))immediately after induction of anesthesia(T_(0))and 30 min(T_(1)),1 h(T_(2))and 2 h(T_(3))after OLV,and preoperative and postoperative white blood cell count,neutrophil count and percentage of neutrophils on postoperative 1st and 3rd days,postoperative PPC and adverse reactions,the 15-item Quality of Recovery Scale(QoR-15)score on postoperative 1st and 2nd days,and post-anesthesia care unit(PACU)stay time and length of hospital stay were compared between the two groups.Results There were no significant differences in the operation time,anesthesia time,one-lung ventilation time,intraoperative blood loss,respiratory recovery time,wake-up time,tracheal intubation time,or operator satisfaction during OLV between the two groups(all P>0.05).Compared with T_(0) in the same group,PaO_(2) decreased and PaCO_(2) increased in both groups from T_(1) to T_(3),and the changes in the control group were more obvious(all P<0.05).Compared with the same group before operation,the white blood cell count,neutrophil count and the percentage of neutrophils in the two groups increased on postoperative 1st and 3rd days,and the increase was more obvious in the control group(all P<0.05).The total incidence of postoperative PPC was 14%(7/50)in the observation group and 34%(17/50)in the control group,with statistically significant difference between the two groups(P<0.05).No statistically significant difference was found in the incidence of adverse reactions after operation between the two groups(P>0.05).The postoperative PACU stay time and hospital stay time in the observation group were shorter than those in the control group,and the QoR-15 scores on postoperative 1st and 2nd days were higher than those in the control group(all P<0.05).Conclusion In elderly patients undergoing thoracoscopic radical resection of lung cancer,continuous medium and low flow oxygen supply to the non-ventilated lung can improve oxygenation function,inhibit postoperative inflammatory response,reduce the occurrence of PPC,and promote postoperative recovery,with high safety.
作者
周俊辉
王鹏浩
奚高原
钟巍
ZHOU Junhui;WANG Penghao;XI Gaoyuan;ZHONG Wei(Department of Anesthesiology,Henan Provincial Chest Hospital,Zhengzhou 450008,China)
出处
《山东医药》
CAS
2022年第11期33-37,共5页
Shandong Medical Journal
基金
河南省医学科技攻关计划—联合共建项目(2018020564)。
关键词
肺通气
并发症
单肺通气
中低流量
给氧方式
肺癌根治术
老年人
lung ventilation
complications
one-lung ventilation
medium and low flow
oxygen supply mode
radical resection of lung cancer
elderly
作者简介
第一作者:周俊辉(1985-),男,主治医师,研究方向为麻醉与围手术期脏器保护。E-mail:zhoujunhui1985@126.com;通信作者:钟巍(1974-),女,副主任医师,研究方向为麻醉与围手术期脏器保护。E-mail:471663005@qq.com。
