Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer:A retrospective analysis

BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.

The Application of Forward Control Nursing in Anesthesia, Recovery, and Rehabilitation of Thoracoscopic Lung Cancer Radical Surgery

Objective: To explore the clinical application effect of formulating the operating room nursing work procedure sheet for elderly lung cancer patients in thoracoscopic radical surgery. Methods: A total of 85 elderly patients with lung cancer treated in our hospital from May 2022 to May 2023 were included as the study population for this research. They were divided into a study group of 42 cases and a regular group of 43 cases. The regular group of elderly patients received routine nursing care, while the study group of elderly patients was provided with the operating room nursing care work procedure sheet. The surgical duration, intraoperative blood loss, time to mobilization, and postoperative complication rate were compared and analyzed between the two groups. Results: Compared to the regular group, the study group had significantly shorter surgical duration and time to mobilization, as well as less intraoperative blood loss (P < 0.05). The overall incidence of postoperative complications in the study group (4.76%) was significantly lower than that in the regular group (19.05%) (P Conclusion: Formulating the operating room nursing work procedure sheet for elderly lung cancer patients can effectively improve surgical efficiency, reduce the incidence of postoperative complications, and promote patient prognosis in thoracoscopic radical surgery. Therefore, this model is worth promoting and adopting in clinical practice.

Impact of thoracic paravertebral block and sufentanil on outcomes and postoperative cognitive dysfunction in thoracoscopic lung cancer surgery

BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(TPVB)or sufentanil(SUF)-based multimodal analgesia.However,the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction(POCD)remain unclear.AIM To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.METHODS This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023.Patients receiving SUF-based multimodal analgesia(n=50)and patients receiving TPVB+SUF-based multimodal analgesia(n=57)were assigned to the control group and TPVB group,respectively.We compared the Ramsay Sedation Scale and visual analog scale(VAS)scores at rest and with cough between the two groups at 2,12,and 24 h after surgery.Serum levels of epinephrine(E),angio-tensin Ⅱ(Ang Ⅱ),norepinephrine(NE),superoxide dismutase(SOD),vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),and S-100 calcium-binding proteinβ(S-100β)were measured before and 24 h after surgery.The Mini-Mental State Examination(MMSE)was administered 1 day before surgery and at 3 and 5 days after surgery,and the occurrence of POCD was monitored for 5 days after surgery.Adverse reactions were also recorded.RESULTS There were no significant time point,between-group,and interaction effects in Ramsay sedation scores between the two groups(P>0.05).Significantly,there were notable time point effects,between-group differences,and interaction effects observed in VAS scores both at rest and with cough(P<0.05).The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased(P<0.05).The TPVB group had lower VAS scores than the control group at 2,12,and 24 h after surgery(P<0.05).The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group(P<0.05).The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery(P<0.05).Both groups had elevated serum E,Ang Ⅱ,and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels,with better indices in the TPVB group(P<0.05).Marked elevations in serum levels of VEGF,TGF-β1,TNF-α,and S-100β were observed in both groups at 24 h after surgery,with lower levels in the TPVB group than in the control group(P<0.05).CONCLUSION TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC,enhances analgesic effects,reduces postoperative stress response,and inhibits postoperative increases in serum VEGF,TGF-β1,TNF-α,and S-100β levels.This scheme also reduced POCD and had a high safety profile.

Effect of dexmedetomidine on immune function, hemodynamics and stress response in elderly patients undergoing thoracoscopic radical resection of lung cancer

Objective:To investigate the effects of dexmedetomidine on immune function, hemodynamics and stress response in elderly patients undergoing thoracoscopic radical resection of lung cancer Methods: 80 elderly patients who was underwent radical thoracoscopic lung cancer surgery from September 2016 to February 2018 were selected. According to the anesthesia method, it was divided into the conventional group and the observation group, 40 cases in each group. The conventional group was anesthetized with propofol, midazolam, sufentanil, and atracurium sulfonate. The observation group was anesthetized with dexmedetomidine on the basis of the conventional group. The changes of vascular dynamics were compared between the two groups before induction (T0), induction 5 min (T1), surgery (T2), extubation immediately (T3) and 5 min after extubation (T4). The changes of immune function, inflammation and stress index in T0, T2 and 24h (T5) were compared between the two groups.Results: There were no significant differences in T0 vascular kinetics, immune function and inflammation stress between the two groups (P<0.05). Compared with T0, MAP, HR and CVP were significantly increased in the conventional group at T3 and T4 (P<0.05), and MAP, HR and CVP were significantly increased in the observation group at T3 (P<0.05). Compared with the conventional group in T3, T4, the MAP, HR, and CVP levels in the observation group at T3 and T4 were significantly lower than the conventional group (P<0.05). Compared with T0, the levels of immune function IgG, IgA, IgM and NK in T2 and T5 were significantly lower in the two groups (P<0.05). There was no significant difference in IgG, IgA, IgM and NK levels between T2 and T5 in the two groups (P>0.05). Compared with T0, the stress levels of NE and E were significantly increased at T2, and the levels of inflammatory factors TNF-αand Cor were significantly increased at T2 and T5 (P<0.05). Compared with the conventional group at T2, the NE and E levels in the observation group were significantly lower than those in the conventional group (P<0.05), and the levels of TNF-α and Cor in the observation group were significantly lower than those in the conventional group at T2 and T5 (P<0.05).Conclusions: Dexmedetomidine anesthesia has little effect on perioperative hemodynamics in elderly patients undergoing thoracoscopic lung cancer radical resection, and can relieve stress response, so it is worthy of clinical application.

Robot-assisted lobectomy in a patient with poor lung function:Another advantage of robot-assisted thoracoscopic surgery

Patients with poor lung function have a high-risk for pulmonary complications following lobectomy.The development of minimally invasive thoracic surgical techniques allows sicker patients to safely undergo lung resection.Robotic lobectomy could benefit these higher risk patients.Here we present a case of a 58-year-old female patient with poor lung function presented with a 3-cm mass in her lower left pulmonary lobe,who successfully underwent lobectomy via robot-assisted thoracoscopic surgery.Her forced expiratory volume in one second was slightly improved compared to the preoperative value.Her forced vital capacity continued to improve in the follow-up period.There was no recorded recurrence during the three years follow-up period.

Influence of the dexmedetomidine combined with parecoxib sodium on inflammatory factor, blood gas analysis and stress hormone levels in patients undergoing radical resection of esophageal carcinoma during one lung ventilation

Objective: To investigate the effect of dexmedetomidine combined with parecoxib sodium on the levels of inflammatory factors, blood gas analysis and stress hormone in patients undergoing radical resection of esophageal carcinoma during one lung ventilation. Methods:According to the random data table, 81 cases of esophageal cancer patients were divided into the control group (n=41) and observation group (n=40), the patients in the two groups underwent left thoracotomy esophageal cancer radical resection, the control group patients were treated with parecoxib sodium, and patients in the observation group were treated with parecoxib sodium combined with dexmedetomidine medetomidine treatment, before induction of anesthesia (T0), 30 min of one lung ventilation (T1) and 120 min after operation (T2) at three time points, the levels of inflammatory factors [tumor necrosis factor-α (TNF-α), C reactive protein (CRP)], blood gas analysis[oxygen partial pressure (PaO2), carbon dioxide partial pressure (PaCO2)] and stress hormone[epinephrine (E), norepinephrine (NE)] of the two groups were compared. Results: Intra group level comparison, compared with the levels of two groups at the T0 moment, the levels of TNF-α, CRPand NE of theT1 and T2 moment were significantly increased, the level of PaO2 were significantly decreased, and T2 moment levels were significantly higher than that of T1 moment, the difference was statistical significance;There were no significant differences between the two groups of the levels of TNF-α, CRP, PaO2, E and NE of the T0 moment, the levels of TNF-α, CRP, E and NE of the observation group at the T1 and T2 moment were significantly lower than the control group, at the same time the PaO2 level was significantly higher than the control group, the difference was statistically significant;There were no statistically significant differences in PaCO2 levels between groups and at any time. Conclusion: Dexmedetomidine combined with parecoxib sodium can effectively relieve the inflammatory stress, improve the levels of the blood gas analysis index and stress hormone during one lung ventilation, has an important clinical value.

Clinical Practice of Evidence-Based PDCA Cycle Management Model in Accelerated Recovery of Lung Cancer Patients

Objective: To explore the nursing effect of evidence-based PDCA cycle management mode in accelerated rehabilitation of patients undergoing thoracoscopic lung cancer radical surgery. Methods: 104 patients who underwent thoracoscopic lung cancer radical surgery in our hospital from June 2022 to February 2023 were randomly divided into control group and intervention group, with 52 cases in each group. The control group implemented evidence-based ERAS clinical pathway management, while the intervention group implemented evidence-based PDCA cycle quality management. The postoperative recovery of the two groups of patients was compared. Results: The postoperative recovery of the intervention group was significantly better than that of the control group. The first time to get out of bed, the first time to eat, the duration of chest drainage tube placement, and the length of hospital stay were significantly shorter than those of the control group. The incidence of postoperative chest complications and hospitalization costs were significantly lower than those of the control group, and patient satisfaction was significantly higher than that of the control group (P Conclusion: Evidence-based PDCA cycle quality management mode can effectively improve the implementation quality of accelerated rehabilitation nursing for patients undergoing thoracoscopic lung cancer radical surgery, and it is worthy of clinical promotion.

Effect of Goal-Directed Fluid Therapy on Lung Function, Cognitive Function and Inflammatory Response in Patients Undergoing Radical Esophageal Cancer Surgery under One-Lung Ventilation

Objective: To explore the effects of goal-directed fluid therapy (GDFT) on lung function, cognitive function and inflammatory response in patients undergoing radical esophageal cancer surgery under one-lung ventilation. Methods: Sixty-seven patients undergoing radical esophageal cancer surgery were divided into GDFT group (GDFT therapy) and control group (conventional liquid therapy). The changes in patients’ pulmonary function, cognitive function and inflammatory response were evaluated. Results: Both alveolar-arterial oxygen partial pressure difference [P(A-a)O2] and respiratory index (RI) increased at one-lung ventilation for 30 minutes (T2) and decreased at one-lung ventilation for 60 minutes (T3), and after surgery (T4) in the two groups, and the GDFT group was lower than the control group (P < 0.05);theoxygenation index (OI) of the two groups decreased at T2, T3, and T4 compared with that at T1 (before one-lung ventilation), and the GDFT group was higher than the control group (P < 0.05). At T4 and T5, the tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), central nervous system specific protein (S100β), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P < 0.05), while interleukin-10 (IL-10) was higher compared to the control group (P < 0.05);the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P < 0.05). Conclusion: GDFT can help prevent lung injury during radical esophageal cancer surgery under one-lung ventilation, reduce the body’s inflammatory response, and reduce the incidence of perioperative cognitive disorder to a certain extent.

Simultaneous Bilateral Thoracoscopic Pneumonectomy for Early Multiple Primary Lung Cancer Feasibility Analysis

Objective:To analyze the feasibility of simultaneous bilateral thoracoscopic lung resection in the treatment of multiple primary lung cancers in the early stage.Methods:The study time range is between March 2019 and March 2021.A sample of 30 patients with early multiple primary lung cancer admitted to this hospital were included,and they were divided into a study group,a control group,and samples within the group using a random number table scheme n=15,patients in the control group underwent staged bilateral thoracoscopic pneumonectomy,and patients in the study group underwent bilateral thoracoscopic pneumonectomy at the same time.The indicators of the two groups were compared and analyzed.Results:There was no significant difference in the operation time and intraoperative blood loss between the two groups(P>0.05).There were significant differences in the VAS score,total length of hospital stay,and total surgical costs on the first day after surgery(P<0.05);there was no significant difference in the two groups'postoperative recovery indicators and the incidence of complications(P>0.05).Conclusion:It is safe and feasible to treat patients with multiple primary lung cancer in both lungs at the same time with simultaneous bilateral thoracoscopic surgery,and is suitable for promotion.

Analysis of factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19

Objective:To explore factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19 and to provide methods for preventing and reducing the incidence of postoperative lung infection in patients with lung cancer.Methods:A total of 92 patients who underwent lung cancer surgery in the Department of Thoracic and Cardiac Surgery of Yichang Central People’s Hospital from January 28,2023,to March 3,2023,were selected.They were divided into a pulmonary infection group(47 cases)and a nonpulmonary infection group(45 cases)according to whether pulmonary infection occurred.General clinical data of patients were collected and collated to analyse the related influencing factors of pulmonary infection in lung cancer patients after recovery from COVID-19.Results:Univariate analysis showed that patient age(≥60 years),fever after COVID-19 infection,oral and laryngeal symptoms,digestive tract symptoms,neurological symptoms,long-term smoking history,hypertension history,and operation time(≥3 h)were correlated with pulmonary infection(all P<0.05).There was no significant correlation between postoperative pulmonary infection and sex,ocular,nasal and tongue symptoms,systemic symptoms,duration of COVID-19,COPD,lobectomy site,incision pain,mechanical ventilation time(≥6 h),drainage tube retention time(3 d),surgical method(P>0.05).Logistic multivariate analysis showed that age(≥60 years old),long operation time(≥3 h)and long-term smoking history were independent influencing factors for postoperative pulmonary infection in patients with radical resection of lung cancer(P>0.05).Conclusion:In this study,older age(≥60 years old),long-term smoking history,and long operation time(≥3 h)were risk factors for pulmonary infection after lung cancer surgery.In the future,active treatment measures can be taken to address these risk factors during the perioperative period to reduce the incidence of postoperative pulmonary infection.

Advances and controversies in the management of early stage nonsmall cell lung cancer

Complete resection continues to be the gold standard for the treatment of earlystage lung cancer.The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer,as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy.There is a growing tendency to perform sublobar resection in selected cases,as,depending on factors such as tumor size,histologic subtype,lymph node involvement,and resection margins,it can produce similar oncological results to lobectomy.Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.

Commentary on impact of pulmonary function on robotic pulmonary resection

Buitrago and colleagues should be commended on an excellent case report on the effective use of the robotic platform for a successful minimally invasive left lower lobectomy for a patient with biopsy proven squamous cell carcinoma.1 Despite a predicted postoperative forced expiratory volume in one second(ppoFEV1)of 23%and a preoperative diffusing capacity for carbon monoxide(DLCO)of 21%,the patient underwent a lobectomy without any intraoperative complications or evidence of disease at 15 months follow-up.Lymph node sampling was performed from 5 stations.The postoperative length of staywas not clearly stated.The authors made several interesting points about the impact of pulmonary function on postoperative outcomes,the oncological efficacy of lobectomy versus sublobar resections,and merits of roboticassisted thoracoscopic surgery(RATS)versus thoracotomy and conventional video-assisted thoracoscopic surgery(VATS).We would like to discuss these points in further detail based on the available evidence in the current literature.

胸椎旁神经阻滞联合全身麻醉在胸腔镜肺癌根治术患者中的应用效果

目的探讨胸椎旁神经阻滞联合全身麻醉在胸腔镜肺癌根治术患者中的应用效果。方法根据麻醉方法的不同将65例胸腔镜肺癌根治术患者分为全麻组(n=31,单纯全身麻醉)和联合组(n=34,胸椎旁神经阻滞联合全身麻醉)。比较两组患者的疼痛情况[视觉模拟评分法(VAS)评分、术后24 h镇痛泵按压次数]、瑞芬太尼用量、苏醒进程指标、应激反应指标[去甲肾上腺素(NE)、超氧化物歧化酶(SOD)、丙二醛(MDA)]及术后并发症发生情况。结果术后2、6、12、24 h,联合组患者VAS评分均明显低于全麻组(P﹤0.01);联合组患者术后24 h镇痛泵按压次数明显少于全麻组(P﹤0.01)。联合组患者瑞芬太尼用量明显少于全麻组,苏醒时间和自主呼吸恢复时间均明显短于全麻组,差异均有统计学意义(P﹤0.01)。术后,两组患者NE、MDA水平均高于本组术前,SOD水平均低于本组术前,联合组患者NE、MDA水平均低于全麻组,SOD水平高于全麻组,差异均有统计学意义(P﹤0.05)。联合组患者术后并发症总发生率低于全麻组(P﹤0.05)。结论胸椎旁神经阻滞联合全身麻醉应用于胸腔镜肺癌根治术患者,不仅能够减轻疼痛程度和应激反应程度,还能够减少阿片类药物用量,降低并发症发生率。

前锯肌平面阻滞对胸腔镜肺癌根治术患者物质能量代谢和胰岛素抵抗的影响

目的探讨前锯肌平面阻滞对胸腔镜肺癌根治术患者物质能量代谢和胰岛素抵抗的影响。方法选取2018年6月—2020年6月在日照市人民医院全身麻醉下行胸腔镜肺癌根治手术的60例患者。采用随机数字表法分为对照组和阻滞组,每组30例。对照组行全身麻醉,阻滞组先在超声引导下行前锯肌平面阻滞,后行全身麻醉。记录两组患者入手术室后5 min(T_(0))、麻醉诱导前(T_(1))、手术切皮时(T_(2))、手术结束时(T_(3))平均血压(BP)和心率(HR)。记录两组患者术后6 h(T_(4))、12 h(T_(5))、24 h(T_(6))、48 h(T_(7))时静止状态及咳嗽状态下行视觉模拟量表评分。两组患者T_(0)、T_(3)、T_(6)、T_(7)时检测C反应蛋白、静息能量消耗、呼吸商、甘油三酯、血糖、胰岛素。采用间接测热法测定静息能量消耗和呼吸商,稳态模型评价胰岛素抵抗指数,全自动生化分析仪测定甘油三酯水平,酶联免疫吸附试验试剂盒检测C反应蛋白。结果两组性别比例、年龄、体质量指数、美国麻醉医生协会分级、手术时间和术中出血量比较,差异均无统计学意义(P>0.05)。阻滞组术中瑞芬太尼用量较对照组少,自主呼吸恢复时间、拔管时间较对照组短(P<0.05)。两组患者T_(0)、T_(1)、T_(2)、T_(3)时BP比较,结果:(1)不同时间点BP比较,差异有统计学意义(P<0.05);(2)两组BP比较,差异无统计学意义(P>0.05);(3)两组BP变化趋势比较,差异有统计学意义(P<0.05)。两组T_(0)、T_(1)、T_(2)、T_(3)时HR比较,结果:(1)不同时间点HR比较,差异有统计学意义(P<0.05);(2)两组HR比较,差异有统计学意义(P<0.05),阻滞组T_(2)、T_(3)时较对照组低(P<0.05);(3)两组HR变化趋势比较,差异有统计学意义(P<0.05)。两组T_(4)、T_(5)、T_(6)、T_(7)时静息状态下VAS比较,结果:(1)不同时间点VAS比较,差异有统计学意义(P<0.05);(2)两组VAS比较,差异有统计学意义(P<0.05),阻滞组T_(4)、T_(5)时较对照组低(P<0.05);(3)两组VAS变化趋势比较,差异无统计学意义(P>0.05)。两组T_(4)、T_(5)、T_(6)、T_(7)时咳嗽状态下VAS比较,结果:(1)不同时间点VAS比较,差异有统计学意义(P<0.05);(2)两组VAS比较,差异有统计学意义(P<0.05),阻滞组T_(4)、T_(5)时较对照组低(P<0.05);(3)两组VAS变化趋势比较,差异有统计学意义(P<0.05)。两组患者T_(0)、T_(3)、T_(6)、T_(7)时C反应蛋白、REE、RQ、甘油三酯、IRI比较,结果:(1)不同时间点C反应蛋白、REE、RQ、甘油三酯、IRI比较,差异均有统计学意义(P<0.05);(2)两组C反应蛋白、REE、RQ、甘油三酯、IRI比较,差异均有统计学意义(P<0.05);(3)两组C反应蛋白、REE、RQ、甘油三酯、IRI变化趋势比较,差异均有统计学意义(P<0.05)。结论前锯肌平面阻滞可减轻胸腔镜肺癌根治术患者炎症反应,改善物质代谢和静息能量消耗,减轻胰岛素抵抗。

右美托咪定复合舒芬太尼病人自控静脉镇痛对胸腔镜下肺癌根治术病人术后免疫功能及呼吸功能恢复的影响

目的探讨右美托咪定(dexmedetomidine,Dex)复合舒芬太尼静脉病人自控静脉镇痛(PCIA)对胸腔镜下肺癌根治术病人术后免疫功能和呼吸功能恢复的影响。方法2020年10月~2022年6月在我院选择ASAⅠ或Ⅱ级择期行胸腔镜下肺癌根治术病人92例,按随机数字表分为舒芬太尼PCIA组(S组)和Dex复合舒芬太尼PCIA组(D组),每组46例,S组有1例术后出血,退出实验,D组有1例术中大出血,退出实验。S组术后PCIA采用舒芬太尼注射液每天1.0μg/kg+盐酸托烷司琼20 mg/150 ml,D组采用Dex每天1.0μg/kg+舒芬太尼注射液每天1.0μg/kg+盐酸托烷司琼20 mg/150ml。记录病人术前1天(T_(0)),术后24小时(T_(1))、48小时(T_(2))、72小时(T_(3))四个时间点的静息、咳嗽疼痛数字评分量表(NRS)评分,SAS评分,抽取静脉血检测CD3^(+)、CD4^(+)、CD8^(+)、CRP、PCT,动脉血行血气分析,计算氧合指数(OI);在T_(2)进行临床肺部感染评分(CPIS)、记录低氧血症、肺水肿、不良反应恶心呕吐、嗜睡、心动过缓、呼吸抑制及寒战的发生情况。结果与S组比较,D组在T_(1)、T_(2)、T_(3)三个时间点,静息、咳嗽NRS评分,SAS评分、CRP、PCT均明显降低,差异有统计学意义(P<0.05),CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、OI值升高,CD8^(+)仅在T_(1)较低(P<0.05);T_(0)时两组静息、咳嗽NRS评分,SAS评分,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),CRP,PCT,OI比较,差异无统计学意义(P>0.05),与T_(0)时比较,两组病人在T_(1)、T_(2)、T_(3)三个时间点静息、咳嗽NRS评分、CRP、PCT明显升高,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、OI、SAS评分降低,CD8^(+)仅在T_(1)、T_(2)升高(P<0.05)。与S组比较,D组恶心呕吐比例和CPIS评分降低[8(17.8%)例、(3.5±1.3)分vs.1(2.2)例、(1.2±1.1)分],低氧血症和肺水肿发生率、嗜睡、心动过缓、呼吸抑制、寒战比例比较,差异无统计学意义(P>0.05)。结论Dex复合舒芬太尼PCIA具有较好的镇痛、镇静效果,即减轻了手术创伤造成的免疫功能抑制程度,又减少阿片类药物的不良反应,还有利于病人术后呼吸功能的恢复,是胸腔镜下肺癌根治术后较安全的PCIA方式。

人工气胸在全腔镜食管癌根治术肺保护性通气策略中的应用研究

目的分析人工气胸在全腔镜食管癌根治术肺保护性通气策略中的应用效果。方法选取2021年1月-2023年3月在该院行人工气胸全腔镜食管癌根治术治疗的88例患者作为研究对象,按随机数表法分为两组,每组各44例,对照组采用常规通气模式,实验组采用肺保护性通气策略模式,比较不同通气模式的临床效果。结果实验组与对照组在气管插管后10 min(T_(1))、单肺通气1 h(T_(2))、手术完毕时(T_(3))和术后24 h(T_(4))的pH和二氧化碳分压(PCO_(2))比较,差异均无统计学意义(P>0.05),两组患者T_(1)、T_(2)、T_(3)和T_(4)时点的氧合指数比较,差异均有统计学意义(P<0.05);实验组与对照组T_(1)、T_(2)和T_(3)时点的静态肺顺应性(Cs)、平台压(Pplat)和气道峰压(Ppeak)比较,差异均有统计学意义(P<0.05);实验组与对照组T1时点的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)和白细胞介素-6(IL-6)水平比较,差异均无统计意义(P>0.05),两组患者T_(2)、T_(3)和T_(4)时点上述指标比较,差异均有统计学意义(P<0.05);对照组肺部并发症发生率为25.00%,高于实验组的9.09%,差异有统计学意义(P<0.05)。结论潮气量(VT)6 mL/kg+100.00%吸入氧浓度+呼气末正压5 cmH_(2)O+肺复张的肺保护性通气策略,用于人工气胸全腔镜食管癌根治术中,能够明显降低术中气道压力,减轻炎症反应,提高通气安全性。

目标导向液体治疗在胸腔镜肺癌根治术中的应用

目的探讨目标导向液体治疗(GDFT)在胸腔镜肺癌根治术中的应用价值。方法94例行胸腔镜肺癌根治术患者随机分为观察组和对照组。观察组采用GDFT,对照组采用常规液体治疗。比较两组患者围术期的血流动力学指标、术中肺通气功能指标、手术观察指标和认知功能。结果在单肺通气1 h和术毕即刻,观察组的平均动脉压(MAP)、中心静脉压(CVP)、呼吸指数(RI)均明显低于对照组,而脑氧饱和度(rSO_(2))和氧合指数(OI)均明显高于对照组(P<0.05或0.01)。观察组胶体补液量、晶体补液量、尿量、补液总量均明显少于对照组,使用血管活性药物构成比低于对照组(P<0.05或0.01)。术后1 d时,观察组的智力状态检查量表(MMSE)评分明显高于对照组,认知功能障碍发生率低于对照组(P<0.05)。结论在胸腔镜肺癌根治术中采用GDFT能够稳定血流动力学,控制容量负荷,减少血管活性药物的使用率,减轻肺通气功能损伤和降低认知功能障碍发生率。

胸腔镜下两种不同术式对早期NSCLC患者的疗效及对其肺功能和预后等的影响

目的探讨胸腔镜下两种不同术式对早期NSCLC患者的疗效及对其肺功能和预后等的影响。方法选取88例早期NSCLC患者(均为ⅠA1期),根据术式差异分为2组。研究组40例,采用胸腔镜下肺楔形切除术治疗,而对照组48例则采用胸腔镜下解剖性肺段切除术治疗,比较2组的临床疗效等差异。结果研究组的手术时间、术中出血量及术后并发症发生率及术后住院时间均优于对照组(P<0.05)。术后2组的肺功能指标均较术前降低,且对照组下降更甚(P<0.05);术后2组的炎性指标均较术前升高,且对照组升高更甚(P<0.05)。术后1年,2组的总生存率及复发率比较,无统计学差异(P>0.05)。结论胸腔镜下肺楔形切除术对早期NSCLC患者的疗效更佳,不仅可缩短手术时间,加快患者术后恢复,同时对肺功能的影响较小,且可降低患者术后的炎性反应程度,最终不影响患者的预后,值得临床推广应用。

信迪利单抗联合紫杉醇、顺铂化疗方案治疗后应用胸腔镜肺癌根治术的价值

目的探讨肺癌患者接受信迪利单抗联合紫杉醇、顺铂化疗方案治疗后采用胸腔镜肺癌根治术的价值。方法104例肺癌患者,以随机数字表法分成研究组(n=52)与对照组(n=52)。两组均接受信迪利单抗联合紫杉醇、顺铂化疗方案治疗,对照组采用开胸肺癌根治术治疗,研究组采用胸腔镜肺癌根治术治疗。比较两组围手术期指标(手术时间、留置引流管时间、住院时间、术中出血量、清扫淋巴结数),肺功能指标[肺活量(VC)、第1秒用力呼气容积(FEV1)、最大通气量(MVV)],疼痛介质[P物质(SP)、前列腺素E2(PGE2)],应激反应[谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)],炎症因子[白细胞介素(IL)-6、IL-17],生命质量[生命质量测定量表(QLQ-C30)评分],并发症发生情况。结果与对照组的(145.13±1.57)min、(6.18±1.41)d、(16.57±1.68)d、(120.06±1.91)ml、(23.57±1.33)个比较,研究组手术时间(127.83±1.52)min、留置引流管时间(3.41±1.35)d、住院时间(12.57±1.51)d更短,术中出血量(108.92±1.65)ml更少,清扫淋巴结数(27.92±1.55)个更多(P<0.05)。两组术后7 d的VC、FEV1、MVV高于本组术前,研究组术后7 d的VC(2.72±0.58)L、FEV1(2.05±0.75)L、MVV(71.95±5.89)L/min高于对照组的(2.29±0.56)L、(1.76±0.61)L、(65.88±4.52)L/min(P<0.05)。两组术后7 d的SP、PGE2水平高于本组术前,研究组术后7 d的SP(7.78±1.34)μg/ml、PGE2(174.93±4.31)ng/L低于对照组的(9.45±1.56)μg/ml、(192.87±5.24)ng/L(P<0.05)。两组术后7 d的SOD、GSH-Px水平低于本组术前,研究组术后7 d的SOD(149.82±4.37)U/ml、GSH-Px(71.63±3.25)U/ml高于对照组的(112.54±4.12)、(58.71±3.71)U/ml(P<0.05)。两组术后1个月的IL-6、IL-17水平低于本组术前,研究组术后1个月的IL-6(6.52±0.86)pg/ml、IL-17(5.12±1.24)pg/ml低于对照组的(7.13±1.03)、(6.45±1.73)pg/ml(P<0.05)。两组术后1个月QLQ-C30评分高于本组术前,研究组术后1个月QLQ-C30评分(72.64±3.92)分高于对照组的(64.81±3.76)分(P<0.05)。研究组术后并发症发生率为7.69%(4/52),低于对照组的25.00%(13/52)(P<0.05)。结论信迪利单抗联合紫杉醇、顺铂化疗方案治疗后应用胸腔镜肺癌根治术治疗肺癌患者,能够改善围手术期指标,促进其肺功能提高,减少疼痛介质分泌,降低应激反应及炎症因子水平,改善生命质量,减少术后并发症发生。

电磁导航支气管镜引导下肺结节定位和CT引导下Hook-wire穿刺定位在肺癌根治术中的应用效果及安全性比较

目的对比电磁导航支气管镜(ENB)引导下肺结节定位和CT引导下Hook-wire穿刺定位在肺癌根治术中的应用效果和安全性。方法将87例行肺癌根治术患者根据定位方式的不同分为CT组(n=45,行CT引导下Hook-wire穿刺定位)和ENB组(n=42,行ENB引导下肺结节定位)。比较两组患者手术情况、切缘阳性率、心肺功能指标、应激指标和并发症发生情况。结果ENB组患者定位时间、定位后等待时间均短于CT组,差异均有统计学意义(P﹤0.05)。术后7天,两组患者左心室射血分数(LVEF)、每搏量(SV)、用力肺活量(FVC)均较术前降低,但ENB组患者LVEF、SV、FVC均高于CT组,差异均有统计学意义(P﹤0.05)。术后1天,两组患者白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)、皮质醇(Cor)水平均较术前升高,但ENB组患者IL-6、IL-8、CRP、Cor水平均低于CT组,差异均有统计学意义(P﹤0.05)。两组患者并发症总发生率比较,差异无统计学意义(P﹥0.05)。结论相比于CT引导下Hook-wire穿刺定位,ENB引导下肺结节定位的定位时间和定位后等待时间更短,能够更加有效地改善患者的心肺功能,减轻应激反应。