高流量湿化氧疗对单孔胸腔镜下肺叶切除术后患者的疗效分析

Efficacy Analysis of High-flow Nasal Oxygen Therapy in Patients Accepting Single-port Video-assisted Thoracoscopic Lobectomy

背景与目的部分胸外科患者术后拔除气管插管后并发低氧血症,常表现为Ⅰ型呼吸衰竭,改善低氧血症是促进患者术后康复的重要因素之一。本研究通过比较经鼻高流量湿化氧疗(high-flow nasal oxygen therapy,HFNO)、无创辅助通气(noninvasive mechanical ventilation,NIMV)及鼻导管吸氧(nasal oxygen breath,NOB)在单孔胸腔镜下肺叶切除术后并发低氧血症患者中的应用,探讨不同吸氧方式的优缺点,进一步探究HFNO在该类患者中的治疗效果。方法选取2021年6月-2022年3月在苏州大学附属第二医院接受单孔胸腔镜下肺叶切除术后并发低氧血症的患者180例,随机分为三组(n=60),分别采用HFNO、NIMV及NOB治疗。观察各组患者使用前、使用1h、使用6 h-12 h及停止使用后的动脉血气分析结果、患者舒适度以及并发症发生率,并使用SPSS 25.0软件进行统计分析,P<0.05为差异有统计学意义。结果对于单孔胸腔镜下肺叶切除术后并发低氧血症的患者,HFNO的治疗效果不逊于NIMV(P=0.333),相较于NOB,HFNO与NIMV均可较快提升患者的氧合指数(partial pressure of oxygen/fraction of inspiration O_(2),PaO_(2)/FiO_(2))(P<0.001)。除此之外,:HFNO在患者使用舒适度、住院时间方面表现出绝对优势(P<0.001,P=0.004),术后并发症较其他两组略有降低(P=0.232),但对于术后低氧血症并发动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))升高的患者,HFNO的治疗效果仍稍逊色于NIMV。结论对于单孔胸腔镜下肺叶切除术后并发低氧血症的患者,HFNO可作为首选治疗方式;但对于术后低氧血症伴随PaCO_(2)升高的患者,仍推荐使用NIMV改善氧合。

Background and objective Patients who underwent lobectomy resection are prone to hypoxemia,and the vast majority present with type I respiratory failure.Thus,improvement of hypoxemia is one of the most important factors to facilitate postoperative recovery of patients.In this study,the superiority-inferiority of different oxygen inhalation methods were compared with high-flow nasal oxygen therapy(HFNO),noninvasive mechanical ventilation(NIMV)and nasal oxygen breath(NOB)in patients with hypoxemia after single-port video-assisted thoracoscopic(VATS)lobectomy,and the clinical efficacy of HFNO in these patients was further investigated.Methods A total of 180 patients from the Second Affiliated Hospital of Soochow University in China with hypoxemia who accepting single-port VATS lobectomy from June 2021 to March 2022 were randomly divided into three groups(n=60),which were treated with HFNO,NIMV and NOB,respectively.The results of arterial blood gas analysis,patient’s comfort score and incidence of complications were observed before,1 h,6 h-12 h and after use.Statistical analyses were conducted using statistical program for social sciences 25.0(SPSS 25.0),and P<0.05 was considered as statistical significance.Results For patients with hypoxemia after accepting single-port VATS lobectomy,HFNO was no less effective than NIMV(P=0.333),and both of whom could fast increase patients’partial pressure of oxygen/fraction of inspiration O_(2)(PaO_(2)/FiO_(2))compared to NOB(P<0.001).Besides,HFNO shows a great advantage in comfort degree and stay length(P<0.001,P=0.004),and incidence of complications were slightly lower than other groups(P=0.232).But it is worthy to note that HFNO is still slightly less effective than NIMV in patients with postoperative hypoxemia accompanied by elevated partial pressure of carbon dioxide(PaCO_(2)).Conclusion For patients with hypoxemia who accepting single-port VATS lobectomy,HFNO can be used as the first choice.However,for patients with postoperative hypoxemia accompanied by elevated PaCO_(2),NIMV is still recommended to improve oxygenation.