不同氧浓度肺复张联合呼气末正压对胸腔镜肺癌根治术患者术后肺部并发症的影响

Effect of lung recruitment maneuvers with different oxygen concentrations combined with positive end-expiratory pressure on postoperative pulmonary complications in patients undergoing thoracoscopic radical resection of lung cancer

目的探究不同氧浓度肺复张联合呼气末正压(PEEP)对胸腔镜肺癌根治术患者术后肺部并发症(PPCs)的影响。方法选择2020年7月至2021年4月期间择期行肺癌根治术患者100例,男59例,女41例,年龄44~73岁,BMI≤30 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法分为两组:FiO_(2)80%肺复张组(H组)和FiO_(2)30%肺复张组(L组),每组50例。两组均于单肺通气(OLV)结束时以不同氧浓度进行肺复张,复张完毕后予PEEP 6~8 mmH_(2)O通气持续至术毕。记录PPCs发生情况、PPCs严重程度分级以及术后住院时间,记录术后谵妄、恶心呕吐、低血压、高血压等不良反应发生情况。结果两组PPCs发生率[L组19例(38%)vs H组24例(48%)]差异无统计学意义。L组PPCs分级≥2级所占比例明显低于H组[5例(10%)vs 13例(26%),P<0.05],L组术后住院时间明显短于H组[(4.5±0.7)d vs(4.9±0.8)d,P<0.05]。两组术后不良反应发生率差异无统计学意义。结论与80%氧浓度肺复张比较,30%氧浓度肺复张不能降低胸腔镜肺癌根治术患者PPCs发生率,但低氧浓度肺复张有助于减轻术后肺部并发症严重程度,缩短术后住院时间。

Objective To evaluate the effect of different oxygen concentrations lung recruitment maneuvers combined with positive end-expiratory pressure(PEEP)on postoperative pulmonary complications(PPCs)in patients undergoing thoracoscopic radical resection of lung cancer.Methods A total of 100 patients,59 males and 41 females,aged 44-73 years,BMI≤30 kg/m^(2),ASA physical statusⅠ-Ⅲ,who underwent elective radical resection of lung cancer from July 2020 to April 2021 were selected.The patients were divided into two groups by random number table method:FiO_(2)80%recruiting group(group H)and FiO_(2)30%recruiting group(group L),50 patients in each group.At the end of one-lung ventilation(OLV),lung recruitment maneuvers were performed with different oxygen concentrations in two groups,and PEEP 6-8 mmH_(2)O ventilation was performed from the lung recruitment maneuvers completed to the end of the operation.The occurrence and severity of PPCs,postoperative hospital stay,and postoperative delirium,nausea and vomiting,hypotension,hypertension and other adverse reactions were recorded.Results There was no significant difference in the incidence of PPCs between the two groups[19 patients(38%)in group L vs 24 patients(48%)in group H].The proportion of patients with PPCs grade≥2 in group L was significantly lower than that in group H[5 patients(10%)vs 13 patients(26%),P<0.05].The postoperative hospital stay in group L was significantly shorter than that in group H[(4.5±0.7)d vs(4.9±0.8)d,P<0.05].There was no statistically significant difference in the incidence of postoperative adverse reactions.Conslusion Compared with the FiO_(2)80%lung recruitment maneuvers,the FiO_(2)30%recruitment does not reduce the incidence of PPCs in patients undergoing thoracoscopic radical resection of lung cancer,but low oxygen concentration can reduce the severity of postoperative pulmonary complications and shorten the length of hospital stay after surgery.