纤支镜吸痰在肺癌术后快速康复中的应用

Aspirating sputum lavation through fiberbronchoscope for enhanced recovery after lung cancer surgery

摘要:

目的：探讨床旁纤支镜吸痰在肺癌术后患者快速康复中的作用。方法：纳入2014年1月至2015年12月期间符合研究条件的肺癌手术患者为研究对象，依据纤支镜吸痰组相同纳入条件，采用1∶1配对原则选择对照组，每组各100例。吸痰组术后采用纤支镜吸痰及物理治疗，对照组仅采用物理治疗。对比分析2组患者术后平均住院日、住院费用、肺部感染、白细胞、中性粒细胞比值、降钙素原（procalcitionin，PCT）情况。结果：与单纯物理治疗相比，纤支镜吸痰联合物理治疗可显著降低患者的术后平均住院日[（7.28±1.84） d vs. （8.07±1.83） d；P=0.010]、肺部感染（5/100 vs. 16/100；P=0.011）及住院费用（P=0.009）。纤支镜吸痰可以显著降低患者术后第3天的降钙素原水平（P=0.031）、术后第3和4天患者的体温、白细胞数（P<0.05）以及术后第3、4、5天的中性粒细胞比值（P<0.05）。结论：肺癌术后纤支镜吸痰可减少患者肺部感染、住院费用、住院时间，从而有利于患者快速康复。

Abstract:

Objective：To investigate the effect of aspirating sputum lavation through fiberbronchoscope on enhanced recovery after surgery in patients with lung cancer. Methods：Two hundred lung cancer patients received surgery in our department from January 2014 to December 2015 were enrolled. These patients were divided into group 1（100 cases with aspirating sputum lavation through fiberbronchoscope and physical therapy） and group 2（100 cases with only physical therapy）. The clinical outcomes of hospital length of stay，hospital costs，the incidence of lung infection，and infection indicators of white blood cells，neutrophils cell ratio，procalcitonin were evaluated by accessing laboratory examination. Results：Compared with cases in group 2，patients in group 1 was associated with decreased postoperative hospital length of stay[（7.28±1.84） days vs. （8.07±1.83） days，P=0.010]，incidence of lung infection （5% vs. 16%，P=0.011），and hospital costs（P=0.009）. For infection indicators，procalcitonin significantly decreased on postoperative 3 days in group 1（P=0.031）. For patients in group 1，body temperature（P<0.05） and white blood cells（P<0.05） were significantly more ap－proximate to normal value on postoperative 3 to 4 days，and neutrophils cell ratio（P<0.05） on postoperative 3 to 5 days. Conclusion：Aspirating sputum lavation through fiberbronchoscopy could ameliorate airway inflammation，consequently reducing lung infections，hospital costs，and hospital length of stay and achieving enhanced recovery after surgery in patients with lung cancer.