HFOV控制胸腹部肿瘤碳离子精准治疗患者呼吸运动的安全性分析  

Safety analysis of high-frequency oscillatory ventilation to control respiratory movement in patients with thoracic and abdominal tumors treated with carbon ion precision therapy

作　　者：唐玉天 王艳芝 王毅 任益民 张雁山 赵文学 王芳 杨文源 Tang Yutian;Wang Yanzhi;Wang Yi;Ren Yimin;Zhang Yanshan;Zhao Wenxue;Wang Fang;Yang Wenyuan(Department of Critical Care Medicine,Wuwei Cancer Hospital,Wuwei 733000,China;Heavy Ion Center,Wuwei Cancer Hospital,Wuwei 733000,China)

机构地区：[1]甘肃省武威肿瘤医院重症医学科,甘肃武威733000 [2]甘肃省武威肿瘤医院重离子中心,甘肃武威733000

出　　处：《中华重症医学电子杂志》2024年第4期344-350,共7页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：甘肃省卫生健康行业科研计划项目(GSWSQN2023-20)

摘　　要：目的探讨高频振荡呼吸(HFOV)管控技术用于控制胸腹部肿瘤碳离子精准治疗患者呼吸运动的安全性。方法选取2023年1月至2024年7月在甘肃省武威肿瘤医院住院的33例HFOV管控下碳离子治疗的胸腹部恶性肿瘤患者为研究组,统计分析患者治疗前、气管插管后、4D-CT定位、靶区勾画30 min、4D-CT复位间、碳离子治疗30 min、碳离子治疗60 min、碳离子治疗90 min、碳离子治疗120 min、复苏、拔管后的心率(HR)、平均动脉压(MAP)、血氧饱和度(SO_(2))、经皮氧分压(tcpO_(2))、经皮二氧化碳分压(tcpCO_(2)),以及自主呼吸状态及HFOV状态膈肌头脚方向最大运动度;选取同期非HFOV下碳离子治疗的42例胸腹部恶性肿瘤患者为对照组,统计2组患者碳离子治疗的摆位误差及临床靶区至计划靶区的外放距离(MPTV),以及不良反应及处理。结果研究组33例患者中,肺、肝脏肿瘤多为多个病灶,最多者24个病灶,所有多病灶患者均一次完成治疗。患者治疗前后及治疗中HR、MAP无差异(P>0.05);而患者治疗前SO_(2)、tcpO_(2)均低于其他阶段(P<0.001);复苏时及拔管后患者SO_(2)低于气管插管至碳离子治疗结束时水平,且高于治疗前(P<0.001);患者碳离子治疗90 min和碳离子治疗120 min时tcpO_(2)、tcpCO_(2)均高于其他阶段(P<0.001),差异均有统计学意义。HFOV时膈肌头脚方向最大运动度为1.30(0.80,2.00)mm,明显低于自主呼吸状态时的19.00(11.30,31.20)mm(P<0.001)。研究组患者碳离子治疗的摆位误差为X轴1.13(0.16,2.02)mm、Y轴1.57(0.12,5.26)mm、Z轴1.21(0.10,6.19)mm,对照组为X轴1.23(0.98,2.85)mm、Y轴2.52(1.27,3.51)mm、Z轴1.64(0.73,3.08)mm,研究组摆位误差低于对照组,差异均有统计学意义(P<0.001)。研究组患者MPTV为X轴1.13(0.70,1.47)mm、Y轴1.57(0.89,2.41)mm、Z轴1.21(0.74,1.61)mm,对照组患者MPTV为X轴1.22(1.15,1.29)mm、Y轴2.51(2.04,2.66)mm、Z轴1.63(1.49,1.75)mm,研究组MPTV的Y轴、Z轴低于对照组,差Objective To investigate the safety of high-frequency oscillatory ventilation(HFOV)control technique for controlling respiratory movement in patients with thoracic and abdominal tumors with carbon ion precision therapy.Methods A total of 33 patients with thoracic and abdominal malignant tumors who were hospitalized in Wuwei Cancer Hospital of Gansu Province from January 2023 to July 2024 and treated with carbon ion under the control of HFOV were selected as the study group.Heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SO_(2)),transcutaneous oxygen pressure(tcpO_(2)),transcutaneous carbon dioxide partial pressure(tcpCO_(2))before treatment,after endotracheal intubation,4D-CT positioning,target delineation for 30 min,4D-CT reduction,carbon ion therapy for 30 min,60 min,90 min,120 min,resuscitation,after extubation,and the maximum motion degree of diaphragm in the direction of head and foot in the state of spontaneous breathing and HFOV were statistically analyzed.42 patients with thoracic and abdominal malignant tumors treated with carbon ion therapy without HFOV were selected as the control group,and the positioning error,margin of planning target volume(MPTV),and adverse reaction and treatment of the two groups were analyzed.Results Most lung and liver tumors had multiple lesions,with a maximum of 24 lesions is 33 cases of the study group.All patients with multiple lesions were treated at one time.There were no significant differences in HR,MAP before,during,or after treatment(P>0.05).SO_(2),tcpO_(2)were lower than those in other stages before treatment(P<0.001).SO_(2)was lower at resuscitation and after extubation than at the end of endotracheal intubation to carbon ion therapy,and higher than before treatment(P<0.001).tcpO_(2)and tcpCO_(2)were higher than those in other stages after 90 minutes and 120 minutes of carbon ion treatment(P<0.001).The maximum motion degree in the head and foot direction of the diaphragm in HFOV was 1.30(0.80,2.00)mm,which was significantly lower than that of 19.00(11.3

关 键 词：高频振荡呼吸 呼吸管控 碳离子放疗 精准放疗 胸腹部肿瘤 

分 类 号：R730.55[医药卫生—肿瘤]