Department of Thoracic Surgery, Wrocław Medical University, Wrocław 53-439, Grabiszyńska 105, Poland.
Department of Pulmonology and Lung Oncology, Wrocław Medical University, Wrocław 53-439, Grabiszyńska 105, Poland.
Can Respir J. 2023 Aug 9;2023:2162668. doi: 10.1155/2023/2162668. eCollection 2023.
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.
The material of the study consisted of 45 obese (BMI 34.8 ± 3.7 kg/m) and 23 nonobese (25.5 ± 3.6 kg/m) 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 CO partial pressure (tcpCO) were performed before and after surgery in search of nocturnal hypoventilation, i.e., the periods lasting at least 10 minutes with tcpCO above 55 mmHg.
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 tcpCO was 53.4 ± 6.1 mmHg, maximal tcpCO was 59.9 ± 8.4 mmHg, and minimal tcpCO was 46.4 ± 6.7 mmHg during the first night after surgery. In these patients, there were higher values of minimal, mean, and maximal tcpCO 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.
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.
夜间低通气可能由于肥胖、合并慢性阻塞性肺疾病（COPD）、阻塞性睡眠呼吸暂停以及/或使用麻醉性镇痛药引起。本研究旨在评估经皮连续二氧化碳描记术评估的接受胸部手术的患者夜间低通气的风险和严重程度。
本研究的材料包括 45 名肥胖患者（BMI 34.8 ± 3.7 kg/m）和 23 名非肥胖患者（25.5 ± 3.6 kg/m），他们因恶性（57 例）和非恶性肿瘤接受了胸部手术。所有患者术后均接受常规镇痛治疗，包括静脉注射硫酸吗啡。在手术前后，对所有患者进行夜间经皮 CO 分压（tcpCO）的连续测量，以寻找夜间低通气，即持续至少 10 分钟且 tcpCO 高于 55mmHg 的时间段。
在 10 名患者（15%）中发现了胸部手术后第一晚的夜间低通气，均为肥胖患者，其中 3 名患者患有 COPD，4 名患者高度怀疑患有中重度阻塞性睡眠呼吸暂停综合征，1 名患者患有慢性日间高碳酸血症。在夜间低通气的患者中，手术后第一晚的平均 tcpCO 为 53.4 ± 6.1mmHg，最大 tcpCO 为 59.9 ± 8.4mmHg，最小 tcpCO 为 46.4 ± 6.7mmHg。在这些患者中，术前的最小、平均和最大 tcpCO 值更高。术后的夜间低通气并未影响住院时间。在观察期的头两年内死亡的 12 名原发性肺癌患者中，有 11 名患者在术后早期没有出现夜间低通气。
胸部手术后患者可能会出现夜间低通气，尤其是患有支气管阻塞、阻塞性睡眠呼吸暂停或慢性日间高碳酸血症的肥胖患者，并且不会影响住院时间。
