Effect Of Early Postoperative Assistance With Coughing And Sputum Excretion On Postoperative Pulmonary Complications In Patients With Lung Cancer

Objective: To investigate whether early postoperative period(within 2 hours after surgery)assistance with coughing and sputum excretion can reduce the incidence of postoperative pulmonary complications in patients with lung cancer.Methods: A total of 300 patients who underwent surgery and were pathologically diagnosed with lung cancer at the first Department of Thoracic Surgery,the tertiary hospital in Kunmingfrom November 11,2022 to January 31,2023 were selected.The patients were divided into the experimental group and the control group 1:1 by random number method,with 150 patients in each group.The patients in the experimental group were assisted sputum excretion by high-frequency tapping on the back and effective cough in the early postoperative period(within 2 hours after surgery)and received routine nursing,while the control group were not assisted with coughing and sputum excretion within 2 hours after surgery,and received routine nursing.The general data of patients such as age,gender,smoking index,basic disease status and perioperative data such as postoperative staging and surgical methods of the two groups were recorded.Vital signs and NRS pain scores were recorded,and blood gas analysis was tested 2h and 24 h after the intervention.The incidence of postoperative pulmonary complications,infection indicators and bedside chest X-ray on the first postoperative day,drainage tube extraction time,postoperative length of stay and mean hospitalization cost were compared between the two groups.Results:1.There were no statistically significant differences in vital signs and NRS pain scores between the two groups on postoperative return to ward and 1h after return(P>0.05).The experimental group had higher Pa O2 and Sa O2 than the control group at different time points after intervention,and the differences were statistically significant(P<0.05).2.Compared with the control group,the experimental group had a higher rate of complete lung recruitment on bedside chest X-ray on the first postoperative day,the difference has statistical significance(P < 0.05).But there was no statistically significant difference in the index of infection on the first postoperative day(P>0.05).3.Postoperative pulmonary complications occurred in 29 patients(9.67%),including 15 cases of pulmonary infection,7 cases of atelectasis,6 cases of pleural effusion and 1 case of persistent air leakage.The incidence of postoperative pulmonary complications in the experimental group(6.00%)was lower than that in the control group(13.33%),and the difference was statistically significant(=4.619,P<0.05).4.Subgroup analysis showed that the incidence of postoperative pulmonary complications in the experimental group was significantly lower than that in the control group in the subgroup with smoking index ≥400 cigarettes(10.26% vs 37.14%,RR=0.193,CI95%: 0.056 to 0.669),the difference was statistically significant.Conclusions:1.Early postoperative assistance with coughing and sputum excretion can safely and effectively remove airway secretions,promote lung recruitment and improve oxygenation,which may be effective measures to reduce postoperative pulmonary complications and may provide a reference for enhanced recovery after surgery programs for patients with lung cancer.2.For lung cancer patients with risk factors such as smoking index ≥400 cigarettes,early postoperative assistance with cough and expectoration may be more effective in preventing postoperative pulmonary complications,but further studies with larger samples are needed.