Zhang Guofei, Wang Lian, Han Jia, Chen Jiali, Wu Jiafeng
Department of Thoracic Surgery, the Second Affiliated Hospital of the Zhejiang University School of Medicine, Hangzhou, China.
Department of Thoracic Surgery, Hangzhou No. 9 People's Hospital & Hangzhou Red Cross Hospital, Qiantang Branch, Hangzhou, China.
Ann Med Surg (Lond). 2025 Mar 28;87(5):2576-2581. doi: 10.1097/MS9.0000000000003202. eCollection 2025 May.
Patients with lung cancer and impaired cough strength have an increased risk of postoperative respiratory complications. This study aimed to investigate the effectiveness of bronchoscopy-assisted postoperative respiratory management in reducing these complications.
This retrospective study included 781 lung cancer patients who received comprehensive postoperative respiratory management between April 2021 and May 2023 in a tertiary care setting. Cough strength was assessed on a scale of 0-5, and patients were categorized by secretion volume. Patients with a cough strength score ≤2 and moderate or higher secretions were identified for bronchoscopy-assisted management.
Twelve patients underwent bronchoscopy-assisted postoperative respiratory management. All 12 patients successfully recovered without requiring postoperative reintubation. Inflammatory marker levels significantly decreased after bronchoscopy and suctioning, with no in-hospital fatalities. The average postoperative hospital stay was 8.0 ± 5.5 days. Among the patients who did not require bronchoscopy-assisted suction, 71 experienced delayed discharge owing to various pulmonary complications, although none required reintubation.
Bronchoscopy-assisted postoperative respiratory management was a promising strategy to prevent respiratory complications in patients with lung cancer and impaired cough strength. Our findings challenge the notion that weak airway competence is a contraindication for lung surgery. Early bronchoscopic intervention and diligent evaluation of airway secretions and cough strength offer substantial potential to improve patient outcomes.
肺癌患者且咳嗽力量受损者术后发生呼吸并发症的风险增加。本研究旨在探讨支气管镜辅助的术后呼吸管理在减少这些并发症方面的有效性。
这项回顾性研究纳入了2021年4月至2023年5月在三级医疗机构接受全面术后呼吸管理的781例肺癌患者。咳嗽力量按0 - 5级进行评估，患者按分泌物量进行分类。咳嗽力量评分≤2且分泌物为中度或更多的患者被确定为接受支气管镜辅助管理。
12例患者接受了支气管镜辅助的术后呼吸管理。所有12例患者均成功康复，无需术后再次插管。支气管镜检查和吸痰后炎症标志物水平显著下降，无院内死亡病例。术后平均住院时间为8.0 ± 5.5天。在不需要支气管镜辅助吸痰的患者中，7例因各种肺部并发症而延迟出院，尽管无人需要再次插管。
支气管镜辅助的术后呼吸管理是预防肺癌且咳嗽力量受损患者呼吸并发症的一种有前景的策略。我们的研究结果对气道功能弱是肺手术禁忌证这一观念提出了挑战。早期支气管镜干预以及对气道分泌物和咳嗽力量的仔细评估为改善患者预后提供了巨大潜力。
