撤机后序贯经鼻高流量湿化氧疗对肺癌根治术后呼吸衰竭患者的影响

Effect of sequential high flow nasal cannula oxygen therapy in patients with respiratory failure after lung cancer operation

摘要:

目的 探讨气管插管撤机后序贯经鼻高流量湿化氧疗对肺癌根治术后呼吸衰竭患者的影响。方法 选取2017年7月—2021年6月就诊于湖北文理学院附属医院（襄阳市中心医院）的120例肺癌根治术后呼吸衰竭患者，根据术后氧疗方式不同分为干预组（60例）和对照组（60例）。两组均接受肺癌根治术，对照组术后气管插管撤机后采用常规面罩吸氧，干预组术后气管插管撤机后序贯经鼻高流量湿化氧疗。比较两组呼吸力学指标、血气指标、血清学指标、舒适度评分、气道湿化评分、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）、不良反应等。结果 治疗后14 d干预组呼吸频率（RR）、气道阻力（Raw）、平均气道压（Pm）均低于对照组（P <0.05）；治疗后14 d干预组血氧饱和度（SaO₂）、氧输送（DO₂）水平、氧合指数（PaO₂/FiO₂）均高于对照组（P <0.05）；治疗后14 d干预组血清内皮素-1（ET-1）、中性粒细胞与淋巴细胞比值（NLR）、缺氧诱导因子1α（HIF-1α）、白细胞介素-6（IL-6）均低于对照组（P <0.05）。干预组舒适度评分、气道湿化评分及APACHEⅡ评分均低于对照组（P <0.05）。干预组不良反应总发生率（5.00%）低于对照组（16.67%）（P <0.05）。结论 经鼻高流量湿化氧疗可有效改善肺癌根治术后呼吸衰竭患者的呼吸力学指标、血气指标、血清学指标及APACHEⅡ评分，降低炎症反应，患者舒适度较好，不良反应较少。

Abstract:

Objective To investigate the effect of sequential high flow nasal cannula oxygen therapy in patients with respiratory failure after lung cancer surgery.Methods A total of 120 patients with postoperative respiratory failure of lung cancer treated in our hospital from July 2017 to June 2021 were included in this study and divided into intervention group (60 cases) and control group (60 cases) according to the different postoperative oxygen therapy method. Both groups received lung tumor resection. The control group received routine mask oxygen inhalation after tracheal intubation and weaning, and the intervention group received high flow nasal cannula oxygen therapy after tracheal intubation and weaning. The respiratory mechanical indexes, blood gas indexes, serological indexes, comfort, airway humidification, acute physiology and chronic health score (APACHE Ⅱ), adverse reactions, and so on were compared between the two groups.Results The levels of RR, raw, and PM in the intervention group were lower than those in the control group (P < 0.05). The levels of SaO₂, PaO₂ / FiO₂ and DO₂ in the intervention group were higher than those in the control group (P < 0.05). The levels of endothelin-1, neutrophil lymphocyte, Hypoxia-inducible factors 1αand Interleukin-6 in intervention group were lower than those in control group (P < 0.05). The comfort, airway humidification and Apache Ⅱ score of the intervention group were lower than those of the control group (P < 0.05). The total incidence of adverse reactions in the intervention group (5.00%) was lower than that in the control group (16.67%) (P < 0.05).Conclusions High flow nasal cannula oxygen therapy can effectively improve blood gas index, respiratory mechanics index, and APACHE Ⅱ score in patients with postoperative respiratory failure of lung cancer, reduce inflammatory reaction, and is more comfortable with fewer adverse reactions.