麻醉后监护室（PACU）中经鼻高流量氧疗减少食管癌手术患者拔管后肺不张：一项随机对照试验
High-flow nasal cannula oxygen therapy in post-anesthesia care unit (PACU) reduces postextubation atelectasis in patients undergoing esophageal cancer surgery: A randomized controlled trial.
摘要(中文译文)
食管癌手术后常发生拔管后肺不张。高流量鼻导管（HFNC）氧疗在麻醉后恢复室（PACU）中对此类患者的疗效尚未得到验证。本随机对照试验纳入100例食管癌术后患者，分为对照组（常规氧疗，5 L/min，n=50）和HFNC组（加温加湿氧疗，FiO₂ 40%，37°C，10 L/min，n=50）。主要结局为拔管前（T1）、干预后30分钟（T2）及PACU出室前（T3）的肺超声评分。次要结局指标包括PaO₂/FiO₂、低氧血症、干预后7天内肺部并发症发生率。HFNC组肺超声评分从T1至T3的下降幅度（平均变化：-5.6分）显著大于对照组（平均变化：-1.4分），组间差异为-4.2分（95% CI：-4.7至-3.7；P<0.001）。在T2和T3时，HFNC组肺超声评分显著更低（T2：8.7±1.2 vs. 12.7±1.5；T3：7.6±1.0 vs. 11.7±1.1；均P<0.001）。HFNC组在T2（325±38 vs. 295±35 mmHg）和T3（340±32 vs. 305±30 mmHg）时的PaO₂/FiO₂比值也显著更高（均P<0.001），且低氧事件发生率（12.0% vs. 28.0%，P=0.046）及术后7天肺部并发症发生率（10.0% vs. 36.0%，P=0.002）更低。镇静评分或血流动力学参数未见显著差异。在PACU中使用HFNC氧疗可能是一种安全有效的手段，可减轻食管癌手术患者拔管后肺不张的严重程度、提高氧合水平并降低早期肺部并发症的发生率。
Abstract
Esophageal cancer surgery frequently leads to post-extubation atelectasis. The efficacy of high-flow nasal cannula (HFNC) oxygen therapy in the post-anesthesia care unit (PACU) for these patients remains unvalidated. This randomized controlled trial enrolled 100 patients after esophageal cancer surgery, allocated to a control group (conventional oxygen therapy at 5 L/min, n = 50) or an HFNC group (heated and humidified oxygen at 40% FiO₂, 37°C, 10 L/min, n = 50). The primary outcome was the lung ultrasound score at pre-extubation (T1), 30 minutes post-intervention (T2), and before PACU discharge (T3). The secondary outcome measures included PaO2/FiO2, hypoxemia, incidence of pulmonary complications within 7 days post-intervention. The reduction in lung ultrasound score from T1 to T3 was significantly greater in the HFNC group (mean change: -5.6 points) than in the control group (mean change: -1.4 points), with a between-group difference of -4.2 points (95% CI: -4.7 to -3.7; P < 0.001). At T2 and T3, lung ultrasound score were significantly lower in the HFNC group (T2: 8.7 ± 1.2 vs. 12.7 ± 1.5; T3: 7.6 ± 1.0 vs. 11.7 ± 1.1; both P < 0.001). The HFNC group also had significantly higher PaO₂/FiO₂ ratios at T2 (325 ± 38 vs. 295 ± 35 mmHg) and T3 (340 ± 32 vs. 305 ± 30 mmHg) (both P < 0.001), and a lower incidence of hypoxic events (12.0% vs. 28.0%, P = 0.046) and 7-day postoperative pulmonary complications (10.0% vs. 36.0%, P = 0.002). No significant differences were found in sedation scores or hemodynamic parameters. The utilization of HFNC oxygen therapy in the PACU may provide a safe and effective means of mitigating the severity of atelectasis subsequent to extubation, enhancing oxygenation levels, and decreasing the incidence of early pulmonary complications in patients who have undergone surgical interventions for esophageal cancer.
如何引用
AMA
Liye Han, Die Ren, Mengqi Zhu, Lili Pan, Yun Zhu. High-flow nasal cannula oxygen therapy in post-anesthesia care unit (PACU) reduces postextubation atelectasis in patients undergoing esophageal cancer surgery: A randomized controlled trial.. PloS one. 2026; doi:10.1371/journal.pone.0348511.
APA
Liye Han, Die Ren, Mengqi Zhu, Lili Pan, Yun Zhu (2026). High-flow nasal cannula oxygen therapy in post-anesthesia care unit (PACU) reduces postextubation atelectasis in patients undergoing esophageal cancer surgery: A randomized controlled trial.. PloS one. https://doi.org/10.1371/journal.pone.0348511
GB/T 7714
Liye Han, Die Ren, Mengqi Zhu, Lili Pan, Yun Zhu. High-flow nasal cannula oxygen therapy in post-anesthesia care unit (PACU) reduces postextubation atelectasis in patients undergoing esophageal cancer surgery: A randomized controlled trial.[J]. PloS one, 2026 doi:10.1371/journal.pone.0348511.
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