胸外科患者夜间低通气的研究。

IF 2.1 4区 医学 Q3 RESPIRATORY SYSTEM
Maciej Majchrzak, Cyryl Daroszewski, Piotr Błasiak, Adam Rzechonek, Paweł Piesiak, Monika Kosacka, Anna Brzecka
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引用次数: 0

摘要

导语:夜间低通气可因肥胖、伴发慢性阻塞性肺疾病(COPD)、阻塞性睡眠呼吸暂停和/或使用麻醉性镇痛药而发生。该研究的目的是通过经皮连续血管造影评估接受胸外科手术的患者夜间低通气的风险和严重程度。材料与方法:本研究的材料包括45例肥胖(BMI 34.8±3.7 kg/m2)和23例非肥胖(25.5±3.6 kg/m2)患者,分别因恶性肿瘤(57例)和非恶性肿瘤行胸外科手术。所有患者术后均给予常规镇痛治疗,包括静脉注射硫酸吗啡。术前和术后进行夜间经皮CO2分压(tcpCO2)测量,以寻找夜间通气不足,即tcpCO2高于55mmhg持续至少10分钟的时间。结果:10例(15%)患者在胸外科手术后第一夜出现夜间低通气,均为肥胖,其中3例为COPD, 4例为中重度OSA综合征,1例为慢性日间高碳酸血症。夜间低通气患者术后第1晚tcpCO2平均值为53.4±6.1 mmHg,最大值为59.9±8.4 mmHg,最小值为46.4±6.7 mmHg。在这些患者中,最小、平均和最大tcpCO2值在术前较高。术后夜间低通气不影响住院时间。在观察的前两年死亡的12例原发性肺癌患者中,术后早期无夜间低通气的患者有11例。结论:胸外科术后患者可能发生夜间低通气,尤其是合并支气管梗阻、阻塞性睡眠呼吸暂停或慢性日间高碳酸血症的肥胖患者,且不影响住院时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nocturnal Hypoventilation in the Patients Submitted to Thoracic Surgery.

Introduction: Nocturnal hypoventilation may occur due to obesity, concomitant chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and/or the use of narcotic analgesics. The aim of the study was to evaluate the risk and severity of nocturnal hypoventilation as assessed by transcutaneous continuous capnography in the patients submitted to thoracic surgery.

Materials and methods: The material of the study consisted of 45 obese (BMI 34.8 ± 3.7 kg/m2) and 23 nonobese (25.5 ± 3.6 kg/m2) patients, who underwent thoracic surgery because of malignant (57 patients) and nonmalignant tumors. All the patients received routine analgesic treatment after surgery including intravenous morphine sulfate. Overnight transcutaneous measurements of CO2 partial pressure (tcpCO2) were performed before and after surgery in search of nocturnal hypoventilation, i.e., the periods lasting at least 10 minutes with tcpCO2 above 55 mmHg.

Results: Nocturnal hypoventilation during the first night after thoracic surgery was detected in 10 patients (15%), all obese, three of them with COPD, four with high suspicion of moderate-to-severe OSA syndrome, and one with chronic daytime hypercapnia. In the patients with nocturnal hypoventilation, the mean tcpCO2 was 53.4 ± 6.1 mmHg, maximal tcpCO2 was 59.9 ± 8.4 mmHg, and minimal tcpCO2 was 46.4 ± 6.7 mmHg during the first night after surgery. In these patients, there were higher values of minimal, mean, and maximal tcpCO2 in the preoperative period. Nocturnal hypoventilation in the postoperative period did not influence the duration of hospitalization. Among 12 patients with primary lung cancer who died during the first two years of observation, there were 11 patients without nocturnal hypoventilation in the early postoperative period.

Conclusion: Nocturnal hypoventilation may occur in the patients after thoracic surgery, especially in obese patients with bronchial obstruction, obstructive sleep apnea, or chronic daytime hypercapnia, and does not influence the duration of hospitalization.

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来源期刊
Canadian respiratory journal
Canadian respiratory journal 医学-呼吸系统
CiteScore
4.20
自引率
0.00%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.
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