不同氧浓度肺复张对肺癌术患者的影响及肺部并发症Probit归因分析

doi:10.3969/j.issn.1007-3205.2023.09.016

摘要/Abstract

摘要： 目的研究和分析不同氧浓度肺复张配合呼气末正压对肺癌术患者应激反应的影响及术后肺部并发症相关因素。
方法选取我院行单侧肺癌根治手术的非小细胞肺癌患者208例作为研究对象，开展回顾性分析，根据氧浓度的不同划分为观察组［124例，吸入气中的氧浓度分数（fraction of inspiration O2，FiO2）调至30%］和对照组（84例，FiO2调至80%）。观察2组临床指证、并发症情况及并发症影响因素分析。应用“单一个体的肺部并发症种类数”来区别以往“单一个体单一并发症的总数”，以“泊松概率回归分析探究肺部并发症种类数的影响因素”区别“二元Logisitc回归分析并发症或者预后有无的影响因素”。
结果对照组瑞芬太尼用量（1.26±0.32） mg、罗库溴铵用量（78.39±10.59） mg、手术时间（125.92±24.18） min、麻醉时间(152.42±31.23)min、住院时间（5.29±0.72）d均要高于观察组［(1.15±0.35) mg、(71.38±10.35) mg、(113.35±23.67) min、(132.88±28.67) min、(4.45±0.72) d］（P＜0.05）。观察组胸腔积液有8例(6.45%)、并发症种类数［1种有17例（13.71%），2种有3例（2.42%）］低于对照组［1种有33例（39.29%），2种有16例（19.05%）,3种有1例（1.19%）］，差异有统计学意义（P＜0.05）。影响肺部并发症种类数的因素有分组（不同氧浓度）、吸烟史、饮酒史、高血压、手术部位、糖尿病、肺功能状态、美国麻醉师协会（American Society of Anesthesiologists，ASA）分级、年龄、手术时间、术中血量、皮质醇、促肾上腺皮质激素（adrenocorticotropichormone，ACTH）、瑞芬太尼用量、最大呼气第一秒呼出的气量的容积（forced expiratory volume in one second，FEV1）、最大通气量（maximum ventilatory volume/minute ，MVV）、氧合指数。
结论低浓度给氧肺复张要优于高浓度，可改善肺功能，促进氧合作用，减少并发症，且应注意肺部并发症的发生是由治疗条件、基础条件、麻醉条件、应激反应多因素影响，以便优化治疗和护理措施。

关键词: 肺肿瘤, 不同氧浓度, 术后肺部并发症

Abstract: Objective To study and analyze the effects of lung recruitment with different oxygen concentrations combined with positive end-expiratory pressure(PEEP) on stress response in patients with lung cancer and related factors of postoperative pulmonary complications.
Methods A total of 208 patients with non-small cell lung cancer (NSCLC) who underwent unilateral radical resection of lung cancer in our hospital were selected as the research subjects for retrospective analysis. According to the different oxygen concentrations, they were divided into the observation group ［fraction of inspiration O2 (FiO2) adjusted to 30%, n=124］ and the control group (FiO2 adjusted to 80%, n=84). Clinical indications, complications and influencing factors of complications were observed in two groups. "The number of types of pulmonary complications in a single individual" was applied to distinguish the previous "total number of single complications in a single individual", and "the influential factors of the number of types of pulmonary complications explored by Poisson probability regression analysis"was used to distinguish "the influential factors of complications or prognosis by binary logisitc regression analysis".
Results The dose of remifentanil (1.26±0.32) mg and rocuronium bromide (78.39±10.59) mg, duration of operation (125.92±24.18) min, duration of anesthesia (152.42±31.23) min, and length of hospital stay (5.29±0.72) d in the control group were higher or longer than those in the observation group ［(1.15±0.35) mg, ( 71.38±10.35) mg, (113.35±23.67) min, (132.88±28.67) min, and (4.45±0.72) d］ in the observation group (P＜0.05). The number of cases ［8(6.45%)］ with pleural effusion and the number of types of complications in the observation group ［17 cases (13.71%) of 1 type, 3 cases (2.42%) of 2 types］ were lower than those in the control group ［33 cases (39.29%) of 1 type, 16 cases (19.05%) of 2 types, 1 case (1.19%) of 3 types］, and the difference was statistically significant (P＜0.05). The factors influencing the number of types of pulmonary complications were grouping (different oxygen concentrations), smoking history, drinking history, hypertension, operation site, diabetes, pulmonary function status, American Society of Anesthesiologists(ASA) classification, age, duration of operation, intraoperative blood volume, cortisol, adrenocorticotropichormone(ACTH), dosage of remifentanil, forced expiratory volume in one second (FEV1), maximum ventilatory volume/minute(MVV), and oxygenation index.
Conclusion Lung recruitment with low concentration of oxygen is superior to that with high concentration, which can improve pulmonary function, promote oxygenation, and reduce complications. It should be noted that the occurrence of pulmonary complications is affected by various indicators, such as treatment conditions, basic conditions, anesthesia conditions and stress response, so as to optimize treatment and nursing measures.

Key words: lung neoplasms, different oxygen concentration, postoperative pulmonary complications

张敏, 梁正, 李朝玉. 不同氧浓度肺复张对肺癌术患者的影响及肺部并发症Probit归因分析[J]. 河北医科大学学报, 2023, 44(9): 1074-1079.

ZHANG Min, LIANG Zheng, LI Chao-yu. Effects of lung recruitment with different oxygen concentrations on patients undergoing surgery for lung cancer and Probit attribution analysis of pulmonary complications[J]. Journal of Hebei Medical University, 2023, 44(9): 1074-1079.

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不同氧浓度肺复张对肺癌术患者的影响及肺部并发症Probit归因分析

Effects of lung recruitment with different oxygen concentrations on patients undergoing surgery for lung cancer and Probit attribution analysis of pulmonary complications

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