BiPAP呼吸机正压给氧对增强肺癌放疗疗效的随机对照试验

目的　观察BiPAP呼吸机正压给氧对放射治疗 (简称放疗 )的影响 ,以探索提高中晚期肺癌治疗的新途径。方法　确诊的肺癌患者 30例随机分为联合治疗组和单纯放疗对照组 ,前者采用BiPAP呼吸机经鼻面罩正压通气给氧联合常规放疗 ,后者采用常规放疗 (6MV X)。观察通气前、后血氧分压 (PaO2 )、血氧饱和度 (SaO2 )变化和放疗前、后胸部X线片、血常规、细胞免疫功能变化 ,以及毒副反应发生情况。结果　①BiPAP呼吸机经鼻面罩正压通气给氧可明显提高PaO2 ,最高可增加 7.5kPa ,同时SaO2 均维持在 95 %以上。肺癌治疗有效率较对照组增加 6 .7个百分点。②治疗组放疗前后细胞免疫功能无明显变化 (P >0 .0 5 ) ,而对照组在放疗后淋巴细胞转化率、CD4及CD4/CD8比值明显降低 (P <0 .0 1 )。③治疗组仅 1例出现白细胞减少 (6 .7% ) ,而对照组有 5例出现白细胞明显降低 (33.3% ) ,需用升白药物才能继续完成放疗。胃肠道反应发生较对照组明显减少。结论　BiPAP呼吸机经鼻面罩正压通气给氧辅助肺癌放疗有一定疗效 ,可明显提高机体氧分压 ,对骨髓及细胞免疫功能有一定保护作用 ,亦能减少放疗所引起的毒副作用

Effect of positive pressure ventilation on radiosensitivity of human pr imary lung cancers

Objective　To investigate the effect of positive pressure ventilation on radiosensitivity of the patients suffering from primary lung cancer. Methods　Thirty cases of lung cancer were randomly divided into two groups: ① combining therapy group: patients treated with posi tive pressure ventilation using BiPAP respirator and radiotherapy;② simple radi otherapy group. The changes of PaO2, SaO2, blood white cells and the cellula r immunological function were observed before and after treatment. Resul ts　Nasal or naso-facial positive pressure ventilation with BiPAP respi rator increased PaO2 significantly with the maximum of 7.5 kPa, SaO2 was ma inteined at above 95%. No significant change for the cellular immunological func tion was found in the combining therapy group （P>0.05）and only one patient with leukopenia（6.7%）. But in the radiotherapy group, the lymphocyte transfor mation efficiency and the ratio of CD4/CD8 were obviously decreased（P<0 .01), and leukopenia was found in 5 cases（33.3%）. Conclusion　 Nasal or naso-facial positive pressure ventilation with BiPAP respirator could improve the effect of radiotherapy for lung cancers. It could also increase PaO 2 significantly and has protective rote to the marrow and cellular immunologic al function of the patients.