手法肺复张在胸腔镜肺叶切除手术术后肺部并发症和苏醒期低氧血症预防中的有效性及安全性

Efficacy and safety of manual lung recruitment in the prevention of postoperative pulmonary complications and hypoxemia during recovery after thoracoscopic lobectomy

目的探讨手法肺复张在胸腔镜肺叶切除手术术后肺部并发症和苏醒期低氧血症预防中的有效性及安全性。方法回顾性选取2020年2月至2022年2月空军军医大学唐都医院胸腔镜肺叶切除手术患者100例,依据并发症预防方法分为手法肺复张组、常规机械通气组两组,各50例。比较两组患者最低血氧饱和度(SpO_(2))、单肺通气时间、手术时间、住重症监护室时间、引流管留置时间、拔管时间、住院时间、苏醒期低氧血症、肺部并发症发生情况、治疗配合度、心率、中心静脉压、平均动脉压、氧合指数和治疗满意度。结果手法肺复张组患者的单肺通气时间、手术时间、住重症监护室时间分别为(107.16±10.88)、(110.84±9.04)、(88.00±9.23)min,均明显短于常规机械通气组[(113.44±10.66)、(121.87±9.95)、(96.50±9.42)min],差异均有统计学意义(P<0.05)。手法肺复张组患者的苏醒期低氧血症发生率为10.00%,明显低于常规机械通气组(48.00%),肺部并发症发生率为6.00%,明显低于常规机械通气组(20.00%),差异均有统计学意义(P<0.05)。手法肺复张组患者的治疗配合度为94.00%,明显高于常规机械通气组(70.00%),差异有统计学意义(P<0.05)。手法肺复张组患者的心率、平均动脉压为(92.75±4.45)次/min、(72.75±4.41)mmHg,明显低于常规机械通气组[(97.45±3.84)次/min、(75.02±4.15)mmHg],氧合指数为(635.26±7.52)mmHg,明显高于常规机械通气组[(629.52±6.24)mmHg],差异均有统计学意义(P<0.05)。手法肺复张组患者的治疗满意度为90.00%,明显高于常规机械通气组(66.00%),差异有统计学意义(P<0.05)。结论和常规机械通气相比,手法肺复张在胸腔镜肺叶切除手术术后肺部并发症和苏醒期低氧血症预防中的疗效更好,安全性、患者配合度和患者满意度更高。

Objective To explore the effectiveness and safety of manual lung recruitment in the prevention of postoperative pulmonary complications and hypoxemia during recovery after thoracoscopic lobectomy.Methods One hundred patients undergoing thoracoscopic lobectomy in Tangdu Hospital,Air Force Military Medical University from February 2020 to February 2022 were retrospectively selected.They were divided into two groups:manual lung recruitment group and conventional mechanical ventilation group according to the prevention methods of complications,with 50 patients in each group.The minimum oxygen saturation(SpO_(2)),one lung ventilation time,operation time,time in intensive care unit,drainage tube retention time,extubation time,hospitalization time,hypoxemia in awakening period,occurrence of pulmonary complications,treatment coordination,heart rate,central venous pressure,mean arterial pressure,oxygenation index and treatment satisfaction of the two groups of patients were comparatively analyzed.Results The single lung ventilation time,operation time and ICU stay time in the manual lung reexpansion group were(107.16±10.88),(110.84±9.04),and(88.00±9.23)minutes,respectively,which were shorter than those in the control group[(113.44±10.66),(121.87±9.95),and(96.50±9.42)minutes],the differences were statistically significant(P<0.05).The incidence of hypoxemia during recovery in the manipulative reexpansion group was 10.00%,which was lower than that in the conventional mechanical ventilation group(48.00%),the incidence of pulmonary complications was 6.00%,which was lower than that in the conventional mechanical ventilation group(20.00%),the difference was statistically significant(P<0.05).The cooperation degree of manipulative reexpansion group was 94.00%,which was higher than that of conventional mechanical ventilation group(70.00%),the difference was statistically significant(P<0.05).The heart rate and mean arterial pressure of the patients in the manual lung recruitment group were(92.75±4.45)beats/min and(72.75±4.41)mmHg,which were significantly lower than those in the conventional mechanical ventilation group[(97.45±3.84)beats/min and(75.02±4.15)mmHg],and the oxygenation index was(635.26±7.52)mmHg,which was significantly higher than those in the conventional mechanical ventilation group[(629.52±6.24)mmHg],the differences were statistically significant(P<0.05).The satisfaction of treatment in the manipulative reexpansion group was 90.00%,which was higher than that in the conventional mechanical ventilation group(66.00%),the differences were statistically significant(P<0.05).Conclusion Compared with conventional mechanical ventilation,manual lung recruitment has better efficacy,safety,patient cooperation and patient satisfaction in the prevention of postoperative pulmonary complications and awakening hypoxemia after thoracoscopic lobectomy.