引用本文:黄钰婷,于美钢,莫毅洁,马 利.连续气道正压通气对胸腔镜肺部手术患者呼吸功能的影响[J].中国临床新医学,2024,17(6):678-682.
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连续气道正压通气对胸腔镜肺部手术患者呼吸功能的影响
黄钰婷,于美钢,莫毅洁,马 利
广西壮族自治区人民医院(广西医学科学院)麻醉科,南宁 530021
摘要:
[摘要] 目的 探讨连续气道正压(CPAP)通气对胸腔镜肺部手术患者呼吸功能的影响。方法 选择2021年6月至2022年12月于广西壮族自治区人民医院择期行胸腔镜肺部手术的60例患者,采用随机数字表法将其分为观察组和对照组,每组30例,经剔除后,最终两组各有29例纳入分析。在单肺通气时,观察组术侧肺持续给予CPAP通气,压力为5 cmH2O,对照组术侧肺无特殊干预措施。于双肺通气20 min(T0)、单肺通气30 min(T1)、单肺通气1 h(T2)时间点进行动脉血气分析,比较两组各时间点氧合指数(OI)水平。比较两组术前及术后24 h中性粒细胞比率、白细胞计数。比较两组术后72 h内肺部并发症发生情况。结果 在T0~T2时间点,两组OI均呈下降趋势(P<0.05),且在T1、T2时间点,对照组的OI水平较观察组更低,差异有统计学意义(P<0.05)。在手术后,两组白细胞计数、中性粒细胞比率较术前显著升高(P<0.05),两组间比较差异无统计学意义(P>0.05)。观察组术后肺部并发症发生率低于对照组,差异有统计学意义(13.79% vs 37.93%; χ2=0.033=4.406,P=0.036)。结论 对胸腔镜肺部手术患者的术侧肺实施CPAP通气能有效提高患者单肺通气时的氧合,降低术后肺部并发症发生率。
关键词:  胸腔镜肺部手术  连续气道正压通气  单肺通气  氧合指数  肺部并发症
DOI:10.3969/j.issn.1674-3806.2024.06.16
分类号:R 614
基金项目:广西壮族自治区卫生厅自筹经费科研课题(编号:桂卫Z2012318)
Effect of continuous positive airway pressure ventilation on respiratory function in patients undergoing thoracoscopic lung surgery
HUANG Yuting, YU Meigang, MO Yijie, MA Li
Department of Anesthesiology, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
Abstract:
[Abstract] Objective To explore the effect of continuous positive airway pressure(CPAP) ventilation on respiratory function in patients undergoing thoracoscopic lung surgery. Methods A total of 60 patients who underwent elective thoracoscopic lung surgery in the People′s Hospital of Guangxi Zhuang Autonomous Region from June 2021 to December 2022 were selected and divided into observation group and control group by random number table method, with 30 cases in each group. After exclusions, 29 cases were included in each of the two groups for analysis. During one-lung ventilation, the observation group received CPAP ventilation on the surgical side of the lung, with a pressure of 5 cmH2O, while the control group received no special intervention measures on the surgical side of the lung. Arterial blood gas analysis was performed at the time point of two-lung ventilation for 20 minutes(T0), the time point of one-lung ventilation for 30 minutes(T1) and the time point of one-lung ventilation for 1 hour(T2), and oxygenation index(OI) level was compared between the two groups at each time point. The neutrophil ratio and white blood cell count were compared between the two groups before operation and 24 hours after operation. The incidence of pulmonary complications within 72 hours after operation was compared between the two groups. Results At the time points from T0 to T2, OI in both groups showed a downward trend(P<0.05), and at the time points of T1 and T2, OI levels in the control group were lower than those in the observation group, and the differences were statistically significant(P<0.05). After operation, the white blood cell count and the neutrophil ratio in the two groups were significantly higher than those before operation(P<0.05), and there were no statistically significant differences between the two groups(P>0.05). The incidence of postoperative pulmonary complications in the observation group was lower than that in the control group, and the difference was statistically significant(13.79% vs 37.93%; χ2=0.033=4.406, P=0.036). Conclusion The implementation of CPAP ventilation in the surgical side of the lung in the patients undergoing thoracoscopic lung surgery can effectively improve the oxygenation of the patients with one-lung ventilation and reduce the incidence of postoperative pulmonary complications.
Key words:  Thoracoscopic lung surgery  Continuous positive airway pressure(CPAP) ventilation  One-lung ventilation(OLV)  Oxygenation index(OI)  Pulmonary complication