健侧肺不同流量持续给氧辅助肺癌胸腔镜根治术对患者炎性反应及术后并发症的影响

doi:10.3760/cma.j.issn.1007-1245.2023.16.009

摘要/Abstract

摘要：

目的　观察健侧肺不同流量持续给氧对肺癌胸腔镜根治术的辅助效果及对患者炎性反应、术后并发症的防治效果。方法　本文为前瞻性研究，选取2021年1月至2022年6月于南阳医学高等专科学校第一附属医院接受肺癌胸腔镜根治术治疗的128例患者为研究对象，采用抽签法随机分为A、B组，各64例。A组中男40例、女24例，年龄（60.25±5.33）岁，术中经非手术健侧肺以1～2 L/min低流量持续给氧；B组中男42例、22例，年龄（61.36±5.28）岁，术中经非手术健侧肺以3～4 L/min中流量持续给氧。比较两组患者的手术情况、治疗情况、血气指标、炎症指标及术后并发症发生情况。组间比较采用χ²检验、独立样本t检验。结果　治疗后，B组手术耗时（180.45±20.26）min、单肺通气时间（170.33±20.29）min，均略高于A组［（178.44±20.32）min、（168.44±20.27）min］（均P>0.05）；B组术后在麻醉后监测治疗室（PACU）停留时间（80.33±10.27）min、住院时间（10.22±5.31）d，均低于A组［（86.65±10.32）min、（13.39±5.28）d］（均P<0.05）。手术开始后30 min时（T1）两组动脉氧分压（PO₂）均降低、动脉二氧化碳分压（PaCO₂）均升高，但差异均无统计学意义（均P>0.05）；B组单肺通气1 h后（T2）的PO₂（185.44±50.32）mmHg（1 mmHg=0.133 kPa），高于A组［（147.44±50.37）mmHg］，PaCO₂（38.25±5.36）mmHg，低于A组［（41.27±5.28）mmHg］。术后首日，B组的白细胞计数计数（6.25±1.45）×10⁹/L，中性粒细胞计数（4.45±1.06）×10⁹/L、血清淀粉样蛋白A（8.25±2.32）mg/L，均低于A组［（7.88±1.27）×10⁹/L、（5.77±1.36）×10⁹/L、（10.47±3.61）mg/L］（均P<0.05）。治疗后，B组的术后并发症发生率6.25%（4/64），低于A组的18.75%（12/64）（P<0.05）。结论　肺癌根治术患者行单肺通气时予以3～4 L/min健侧肺持续给氧可在不影响手术指标的同时促进患者术后恢复，对改善患者血气指标、降低炎性反应及术后并发症发生风险有积极作用。

关键词:

肺癌, 根治术, 单肺通气, 健侧肺给氧, 炎性反应, 术后并发症

Abstract:

Objective　To observe the auxiliary effect of different flow volumes of oxygen in the healthy side lungs for thoracoscopic radical operation of lung cancer and the prevention and treatment effect on patients' inflammatory reaction and postoperative complications. Methods　This study was a prospective study. One hundred and twenty-eight patients who received thoracoscopic radical surgery for lung cancer in First Hospital, Nanyang Medical College from January 2021 to June 2022 were selected as the research objects, and were divided into groups A and B by the lottery method, with 64 cases in each group. There were 40 males and 24 females in group A; they were (60.25±5.33) years old. There were 42 males and 22 females in group B; they were (61.36±5.28) years old. Group A were continuously given 1-2 L/min oxygen delivery through their non-operative healthy lungs during the operation, and group B 3-4 L/min oxygen. The operation status, treatment status, blood gas indicators, inflammation indicators, and postoperative complications were compared between the two groups. χ² and t tests were applied. Results　After the treatment, the operation time and the time of single lung ventilation in group B were (180.45±20.26) min and (170.33±20.29) min, and those in group A were (178.44±20.32) min and (168.44±20.27) min (both P>0.05). The time staying in the monitoring treatment room after anesthesia and hospital stay in group B were shorter than those in group A [(80.33±10.27) min vs. (86.65±10.32) min and (10.22±5.31) d vs. (13.39±5.28) d; both P<0.05]. Thirty minutes after the operation beginning (T1), the arterial partial pressures of O₂ (PO₂) in both groups decreased, and the arterial partial pressures of CO₂ (PaCO₂) increased in both groups; however, there were no statistical differences between these two groups (both P>0.05). One hour after the one-lung ventilation (T2), the PO₂ in group B was higher than that in group A [(185.44±50.32) mmHg (1 mmHg=0.133 kPa) vs. (147.44±50.37) mmHg], and the PaCO₂ in group B was lower than that in group A [(38.25±5.36) mmHg vs. (41.27±5.28) mmHg]. On the first day after the surgery, the white blood cell count, neutrophil count, and level of serum amyloid protein A in group B were lower than those in group A [(6.25±1.45) ×10⁹/L vs. (7.88±1.27) ×10⁹/L, (4.45±1.06) ×10⁹/L vs. (5.77±1.36) ×10⁹/L, and (8.25±2.32) mg/L vs. (10.47±3.61) mg/L; all P<0.05]. After the treatment, the postoperative complication rate of group B was lower than that of group A [6.25% (4/64) vs. 18.75% (12/64); P<0.05]. Conclusions　Continuous oxygenation of 3-4 L/min to the healthy lungs during single lung ventilation in patients undergoing radical resection of lung cancer does not affect surgical indicators and can promote postoperative recovery. It has positive effects on improving blood gas indicators, reducing inflammatory reaction and risk of postoperative complications.

Key words:

Lung cancer, Radical resection, Single lung ventilation, Contralateral lung oxygenation, Inflammatory reaction, Postoperative complications

郭靖赵天增.

健侧肺不同流量持续给氧辅助肺癌胸腔镜根治术对患者炎性反应及术后并发症的影响 [J]. 国际医药卫生导报, 2023, 29(16): 2259-2263.

Guo Jing, Zhao Tianzeng.

Inflammatory reaction and postoperative complications of patients taking thoracoscopic radical resection of lung cancer assisted by different flow volumes of continuous oxygen in their contralateral lungs [J]. International Medicine and Health Guidance News, 2023, 29(16): 2259-2263.

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