摘要
目的 对比针对北方寒冷地区肺外科围手术期的肺不张和肺部感染，在常规治疗基础上加用围术期的强化的肺功能训练以及纤维支气管镜下治疗参与的气道管理效果差异。方法 回顾性分析我院2020年6月至2023年12月期间我院收治的常见慢性肺疾病基础上行肺手术的患者60例，观察组为在围手术期采用强化的肺功能训练以及纤维支气管镜下治疗参与的气道管理患者30例。选择前期行肺手术，按照常规管理患者30例为对照组。比较两组的临床相关结果的效果差异。结果 在保证疗效的情况下，观察实验组术前后的以肺功能为主要指标的气道管理质量的区别。比较两组患者治疗效果指标：症状和体征（体温、呼吸频率和氧饱和度）；血清学指标（血气分析、白细胞、超敏C反应蛋白 （hs-CRP）；肺功能指标（包括潮气容积（VT，ml），一秒用力呼气容积（FEV1.0，L），FVC1.0%，MVV实/预测。）及X线胸片检查。结果治疗前，两组患者评分比较差异无统计学意义（P>0.05）；治疗后，观察组患者的症状和体征（体温、呼吸频率和氧饱和度）；血清学指标（血气分析、白细胞、超敏C反应蛋白（hs-CRP）；肺功能指标（包括潮气容积（VT，ml），一秒用力呼气容积（FEV1.0， L），FVC1.0%，MVV实/预测。）及X线胸片检查均显著均好于对照组患者。两组患者治疗后的差异有统计学意义 （P<0.05）。结论 针对北方寒冷地区肺外科围手术期的肺不张和肺部感染，在常规治疗基础上加用强化的肺功能训练以及纤维支气管镜下治疗参与的气道管理可明显减轻肺部感染，提高手术质量，其治疗效果显著，值得推广。
关键词： 北方寒冷地区；肺外科；围手术期；气道管理；疗效观察
Abstract
Objective To compare the difference in the effect of airway management with enhanced pulmonary function training and fiberbronchoscope treatment in perioperative period for atelectasis and pulmonary infection in lung surgery in cold northern regions. Methods A retrospective analysis was conducted on 60 patients who underwent lung surgery based on common chronic lung diseases admitted to our hospital from June 2020 to December 2023. The observation group consisted of 30 patients who underwent intensive pulmonary function training and fiberbronchoscope treatment in the perioperative period. 30 patients who underwent lung surgery in the early stage and were managed according to routine management were selected as the control group. The difference in the effect of clinical related results between the two groups was compared. Results While ensuring the efficacy, the difference in airway management quality with pulmonary function as the main indicator before and after surgery was observed in the experimental group. The treatment effect indicators of the two groups were compared: symptoms and signs (body temperature, respiratory rate and oxygen saturation); serological indicators (blood gas analysis, white blood cells, high-sensitivity C-reactive protein (hs-CRP); pulmonary function indicators (including tidal volume (VT, ml), forced expiratory volume in one second (FEV1.0, L), FVC1.0%, MVV actual/predicted.) and X-ray chest film examination. Results Before treatment, there was no significant difference in the scores between the two groups of patients (P>0.05); after treatment, the symptoms and signs (body temperature, respiratory rate and oxygen saturation); serological indicators (blood gas analysis, white blood cells, high-sensitivity C-reactive protein (hs-CRP); pulmonary function indicators (including tidal volume (VT, ml), forced expiratory volume in one second (FEV1.0, L), FVC1.0%, MVV actual/predicted.) and X-ray chest film examination of the observation group were significantly better than those of the control group. The difference between the two groups after treatment was statistically significant (P<0.05). Conclusion For perioperative atelectasis and pulmonary infection in lung surgery in cold northern regions, adding enhanced lung function training and airway management with fiberbronchoscope treatment on the basis of conventional treatment can significantly reduce lung infection and improve the quality of surgery. Its treatment effect is significant and worthy of promotion.
Key words： Cold northern regions; Lung surgery; Perioperative period; Airway management; Efficacy observation
参考文献 References
[1] 支修益,刘伦旭.中国胸外科围手术期气道管理指南(2020版)编写委员会.中国胸外科围手术期气道管理指南(2020版)[J].中国胸心血管外科临床杂志,2021,28(3):251-262.
[2] BadeBC,DelaCruzCS.Lungcancer2020:epidemiolo-gy,etiology,andprevention[J].ClinChestMed,2020,41(1):1-24.
[3] 王天佑,胸外科围手术期肺保护中国专家共识(2019版)专家组,中国医学基金会胸外科专业委员会.胸外科围手术期肺保护中国专家共识(2019版)[J].中国胸心血管外科临床杂志,2019,26(9):835-842.
[4] Wu GX, Khojabekyan M, Wang J, et al. Survival following lung resection in immunocompromised patients with pulmonary invasive fungal infection[J]. Eur J Cardiothorac Surg, 2016, 49 (1) :314-320.
[5] Oshima H, Nakamura M, Watanabe O, et al. Dexmedetomidine provides less body motion and respiratory depression during sedation in double-balloon enteroscopy than midazolam[J]. SAGE Open Med, 2017, 5: 1-7.
[6] 张晓,高芸,李雪华,等.纤维支气管镜吸痰灌洗治疗对重症肺炎患者的疗效及炎症标志物水平的影响[J].泰山医学院报,2021,42(3):203-206.
[7] Davis KR, Vadakkan DT, Krishnakumar EV, et al. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia[J].Lung India, 2015, 32 (2) :162-164.
[8] Low DE, Allum W, Manzoni G D, et al. Guidelines for Perioperative care in esophagectomy: Enhanced Recovery After Surgery(ERAS) society recommendations[J]. WorldJSurg,2019,43(2):299-330.
[9] 孙建,任柏沉,杨帆,等.纤维支气管镜吸痰联合常规抗感染治疗对重症肺部感染患者肺功能及炎症状态的影响[J].海南医学院学报, 2016, 22 (13) :1373-1376.
[10] Al-Qadi MO,Cartin-Ceba R, Kashyap R, et al. The Diagnostic Yield, Safety, and Impact of Flexible Bronchoscopy in Non-HIV Immunocompromised Critically Ill Patients in the Intensive Care Unit. Lung, 2018, 196(6):729-736.
[11] 房雅君，姚艳玲. 快速康复外科护理在胸腔镜下肺切除术患者中的应用研究[J].中国肿瘤临床与康复,2022,29(9): 1137-1140.
[12] Li X, Wang X, Jin S, et al. The safety and efficacy of dexmedetomidine remifentanil in children undergoing flexible bronchoscopy: a retrospective dosefi nding trial[J]. Medicine(Baltimore), 2017, 96(11): e6383.
[13] 俸成钢，唐际富．电视胸腔镜肺叶切除术对肺癌患者心肺功能的康复作用[J].解放军预防医学杂志,2018,36(5):528-584.
[14] Gao Y, Kang K, Liu H, et al. Effect of dexmedetomidine and midazolam for fl exible fi beroptic bronchoscopy in intensive care unit patients: a retrospective study[J]. Medicine (Baltimore), 2017, 96(25): e7090.
[15] 魏志杰,张靖华,孟利芳.呼吸道管理及呼吸训练对肺癌术后患者肺功能指标、排痰效果、肺部感染及康复情况的影响[J].癌症进展,2021,19(13):1386-1389.
[16] 郜杨,王洪亮,房霞,等. 右美托咪定在重症医学科患者纤维支气管镜检查中的应用[J]. 中国老年学杂志,2016, 36(13): 3241-3242.
[17] 漆奋强,袁天柱,吴根社,等.电视胸腔镜肺叶切除术在老年肺癌患者中的应用及对代谢反应、疼痛应激与心肺运动耐力的影响[J].中国老年学杂志,2018,38(10):2353-2355．