摘要
目的评价择期接受单肺通气胸腔镜手术患者术后1 h使用湿化高流量鼻导管通气(humidified high flow nasal cannula,HFNC)和传统经鼻氧疗对于术后早期氧合状态、低氧血症及术后肺部并发症发生率的影响。方法采用多中心前瞻性随机对照的研究方法,选择在单肺通气下接受胸腔镜下肺部楔形切除或单肺叶切除的患者80例,年龄在18~60岁,通过随机数字表法将患者分为HFNC组(H组)和对照组(C组),每组40例。H组患者在气管导管拔管后1 h内,采用广州鲸科HF807C型呼吸湿化治疗仪,由经过专业培训的人员使用HFNC(氧流量50~60 L/min)进行吸氧,滴定法确定氧浓度并维持外周脉搏血氧饱和度≥95%;C组患者则在气管导管拔管后1 h内,使用传统的鼻导管吸氧,维持外周脉搏血氧饱和度≥95%。记录患者术前及术中相关数据、术后1 h低氧血症(PaO_(2)/FiO_(2)<300)的发生率及血气分析结果、术后24 h VAS评分及呼吸不适评分、术后7 d内肺部并发症发生率及是否需要再次插管或无创呼吸机治疗、住院时间。结果H组患者术后1 h PaO_(2)较C组明显增加;两组患者术后1 h低氧血症发生率、VAS评分、呼吸不适评分、术后肺部并发症情况、需要再次插管或接受无创呼吸机治疗及住院时间的比较差异无统计学意义(P>0.05)。结论与传统经鼻氧疗相比,单肺通气胸腔镜手术后早期使用HFNC可以增加患者动脉氧分压,有利于提高患者缺氧耐受性。
Objective To evaluate the effects of early high-flow nasal cannula oxygen therapy(HFNC)and traditional nasal oxygen therapy on the incidence of early hypoxemia and postoperative pulmonary complications in patients undergoing one-lung ventilation thoracoscopic surgery.MethodsEighty patients aged 18-60 years who underwent thoracoscopic wedge resection or single lobectomy under one-lung ventilation were enrolled in a multi-center prospective randomized controlled study.The patients were divided into two groups by random number table method,the high-flow nasal cannula oxygen therapy group(H group)and the control group(C group),with 40 patients in each group.In the H group,within 1 hour after extubation,oxygen was inhaled by professionally trained personnel using HFNC(oxygen flow rate 50-60 L/min),and oxygen concentration was determined by titration method and peripheral pulse oxygen saturation was maintained at≥95%.Patients in group C received oxygen inhalation by nasal catheter or mask within 1 hour after extubation to maintain peripheral pulse oxygen saturation≥95%.General information and intraoperative information of all patients were collected.The incidence of hypoxemia in the resuscitation room,postoperative pain score and respiratory discomfort score at 24 hours were recorded.Postoperative pulmonary complications and the need for re-intubation or non-invasive ventilator treatment were recorded at 1 to 7 days.Meanwhile,the length of hospital stay of the patients was recorded.Results Compared with group C,the FiO_(2) and PaO_(2) of patients in the H group increased significantly in the PACU,and the difference was statistically significant(P<0.05).There was no significant difference in the oxygenation index and the incidence of hypoxemia between the two groups(P>0.05).There was no statistical difference between the two groups of patients in postoperative pain score,respiratory discomfort score,postoperative pulmonary complications,reintubation or non-invasive ventilator treatment,and length of hospital stay(P>
作者
赵昭
罗涛
李亚丽
李俊杰
廖步程
高文莉
徐春宇
曾杰
刘志恒
周必强
ZHAO Zhao;LUO Tao;LI Ya-li;LI Jun-jie;LIAO Bu-cheng;GAO Wen-li;ZENG Jie;LIU Zhi-heng;ZHOU Bi-qiang(Department of Anesthesiology,Shenzhen Second People's Hospital,First Affiliated Hospital of Shenzhen University,Shenzhen 518028,Guangdong,China;不详)
出处
《广东医学》
CAS
2021年第9期1039-1043,共5页
Guangdong Medical Journal
基金
深圳市医疗卫生“三名工程”项目(SZSM201612026)。
关键词
单肺通气
低氧血症
氧疗
麻醉复苏
one lung ventilation
hypoxemia
oxygen inhalation therapy
anesthesia recovery period
