预防性使用经鼻高流量湿化氧疗减少老年非小细胞肺癌患者术后肺部并发症的倾向性评分匹配研究  

Prophylactic high-flow nasal cannula oxygen therapy can reduce postoperative pulmonary complications in elderly patients with non-small cell lung cancer:A propensity score matching study

作　　者：涂秀华[1] 雷妹 陈彦清 林嵘嘉 黄瑞珍[1] 项春梅 TU Xiuhua;LEI Mei;CHEN Yanqing;LIN Rongjia;HUANG Ruizhen;XIANG Chunmei(Department of Thoracic Surgery,Fujian Provincial Hospital,Fuzhou,350013,P.R.China)

机构地区：[1]福建省立医院胸外科,福州350013

出　　处：《中国胸心血管外科临床杂志》2024年第9期1274-1280,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨预防性使用经鼻高流量湿化氧疗(high-flow nasal cannula oxygen therapy,HFNC)对减少老年非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后肺部并发症(postoperative pulmonary complication,PPC)的临床价值。方法回顾性分析2021年1月—2022年3月于福建省立医院胸外科行胸腔镜肺叶/肺段切除术老年(>60岁)NSCLC患者的临床资料。根据术后是否使用HFNC将患者分为常规氧疗(conventional oxygen therapy,CO)组和HFNC组,按1∶1倾向性评分将两组进行匹配。比较两组PPC发生率,术后第1 d、3 d、5 d白细胞、降钙素原和C反应蛋白及术后住院时间。结果共纳入343例患者,其中男165例、女178例,平均年龄(67.25±4.79)岁。53例(15.45%)术后使用HFNC。匹配前,两组性别、合并慢性阻塞性肺疾病患者比例、病理类型和分期差异有统计学意义(P<0.05)。每组各有42例患者匹配成功,匹配后两组基线资料差异无统计学意义(P>0.05)。匹配后结果显示,HFNC组PPC发生率明显低于CO组[10/42(23.81%)vs.19/42(45.23%),P=0.039];HFNC组术后第3 d白细胞及降钙素原和术后第5 d白细胞水平明显低于CO组[(8.92±2.91)×10^(9)/L vs.(10.62±2.67)×10^(9)/L;0.26(0.25,0.44)μg/L vs.0.31(0.25,0.86)μg/L;(7.68±1.58)×10^(9)/L vs.(8.86±1.76)×10^(9)/L;P均<0.05]。其余炎症指标水平及术后住院时间差异无统计学意义(P>0.05)。结论预防性使用HFNC可降低老年NSCLC患者PPC发生率和术后炎症指标水平,但无法缩短术后住院时间。Objective To investigate the clinical value of prophylactic high-flow nasal cannula oxygen therapy(HFNC)in reducing postoperative pulmonary complication(PPC)in elderly patients with non-small cell lung cancer(NSCLC).Methods The clinical data of elderly patients(over 60 years)with NSCLC who underwent video-assisted thoracoscopic lobectomy or segmental resection at the Department of Thoracic Surgery,Fujian Provincial Hospital from January 2021 to March 2022 were retrospectively analyzed.According to whether receiving HFNC after surgery,they were divided into a conventional oxygen therapy(CO)group and a HFNC group.The CO group were matched with the HFNC group by the propensity score matching method at a ratio of 1:1.We compared PPC incidence,white blood cell(WBC)count,procalcitonin and C-reactive protein on postoperative day(POD)1,3 and 5 and postoperative hospital stay between the two groups.Results A total of 343 patients(165 males,178 females,average age of 67.25±4.79 years)were enrolled,with 53(15.45%)receiving HFNC.Before matching,there were statistical differences in gender,rate of combined chronic obstructive pulmonary disease,pathology type and TNM stage between the two groups(all P<0.05).There were 42 patients successfully matched in each of the two groups,with no statistical difference in baseline characteristics(P>0.05).After propensity score matching,the results showed that the PPC incidence in the HFNC group was lower than that in the CO group(23.81%vs.45.23%,P=0.039).WBC count on POD 3 and 5 and procalcitonin level on POD 3 were less or lower in the HFNC group than those in the CO group[(8.92±2.91)×10^(9)/L vs.(10.62±2.67)×10^(9)/L;(7.68±1.58)×10^(9)/L vs.(8.86±1.76)×10^(9)/L;0.26(0.25,0.44)μg/L vs.0.31(0.25,0.86)μg/L;all P<0.05].There was no statistical difference in the other inflammatory indexes or the postoperative hospital stay between the two groups(P>0.05).Conclusion Prophylactic HFNC can reduce the PPC incidence and postoperative inflammatory indexes in elderly patients with NSCLC,bu

关 键 词：经鼻高流量湿化氧疗 非小细胞肺癌 术后肺部并发症 老年患者 

分 类 号：R734.2[医药卫生—肿瘤]