无呼吸性气流通气联合持续中低流量给氧在胸腔镜肺癌单肺通气肺保护中的效果

Effect of apneic ventilation combined with continuous low-to-moderate flow oxygen therapy on lung protection during one-lung ventilation in thoracoscopic lung cancer surgery

摘要:

目的 探讨无呼吸性气流通气联合持续中低流量给氧在胸腔镜肺癌单肺通气肺保护中的效果。方法 前瞻性选取2021年1月—2023年6月在宁波市杭州湾医院接受胸腔镜下肺癌根治术患者102例，采用随机数字表法分为对照组和观察组（各51例）。对照组单肺通气后采用持续中低流量给氧，观察组在对照组的基础上采用无呼吸性气流通气。对比两组呼吸指数（RI）、动脉血二氧化碳分压（PaCO₂）、肺萎陷及手术视野暴露效果、肺组织损伤评分、肺组织细胞凋亡指数、术后住院时间、术后机械通气辅助时间及并发症。结果 观察组与对照组麻醉诱导后1 min（T₀）、单肺通气后30 min（T₁）、单肺通气后1 h（T₂）时刻的RI、PaCO₂水平比较，结果 ①不同时间点RI、PaCO₂水平比较，差异均有统计学意义（F =11.265、13.785，均P <0.05）；②观察组与对照组RI、PaCO₂水平比较，差异均有统计学意义（F =9.143、11.068，均P <0.05）；③两组RI、PaCO₂水平变化趋势比较，差异均有统计学意义（F =10.372、12.412，均P <0.05）。观察组肺萎陷及手术视野暴露总有效率高于对照组（P <0.05）。观察组肺组织损伤评分和肺组织细胞凋亡指数均低于对照组（P <0.05）。观察组术后住院时间、术后机械通气辅助时间均短于对照组（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 无呼吸性气流通气联合持续中低流量给氧在胸腔镜肺癌单肺通气肺保护中效果确切，可减轻肺组织损伤，改善RI、PaCO₂水平，促进术后康复，且安全性可靠。

Abstract:

Objective To analyze the effect of apneic ventilation combined with continuous low-to-moderate flow oxygen therapy on lung protection during one-lung ventilation in thoracoscopic lung cancer surgery.Methods A total of 102 patients who underwent thoracoscopic radical resection for lung cancer at Ningbo Second Hospital from January 2021 to June 2023 were prospectively included and divided into the control group and the observation group (51 cases in each group) by the random number table method. In the control group, continuous low-to-moderate flow oxygen therapy was adopted after one-lung ventilation, while in the observation group, apneic ventilation was additionally adopted. The respiratory index (RI), arterial partial pressure of carbon dioxide (PaCO₂), degree of lung collapse and quality of surgical field exposure, lung tissue injury score, pulmonary cell apoptosis index, postoperative length of hospital stay, duration of postoperative mechanical ventilation and complications were compared between the two groups.Results The RI and PaCO₂ at 1 minute after anesthesia induction (T₀), 30 minutes after one-lung ventilation (T₁), and 1 hour after one-lung ventilation (T₂) in the observation group and the control group were compared via the repeated measures ANOVA, which demonstrated that the RI and PaCO₂ differed across the time points (F = 11.265 and 13.785, both P < 0.05) and between the groups (F = 9.143 and 11.068, both P < 0.05), and that the comparison of the change trends of RI and PaCO₂ between the two groups showed statistically significant differences (F =10.372 and 12.412, both P < 0.05). The overall effective rate of the observation group was higher than that of the control group (P < 0.05). The lung tissue injury score and the pulmonary cell apoptosis index in the observation group were both lower than those in the control group (P < 0.05). The duration of postoperative mechanical ventilation and postoperative length of hospital stay in the observation group were both shorter than those in the control group (P < 0.05). There was no statistically significant difference in the overall incidence of complications between the control group and the observation group (P > 0.05).Conclusion Apneic ventilation combined with continuous low-to-moderate flow oxygen therapy exhibits a definite effect on lung protection during one-lung ventilation in thoracoscopic lung cancer surgery. It reduces lung tissue injury, improves RI and PaCO₂, promotes postoperative recovery, and is safe and reliable.