目的

探讨高频振荡呼吸（HFOV）管控技术用于控制胸腹部肿瘤碳离子精准治疗患者呼吸运动的安全性。

方法

选取2023 年1 月至2024 年7 月在甘肃省武威肿瘤医院住院的33 例HFOV管控下碳离子治疗的胸腹部恶性肿瘤患者为研究组，统计分析患者治疗前、气管插管后、4D-CT 定位、靶区勾画30 min、4D-CT 复位间、碳离子治疗30 min、碳离子治疗60 min、碳离子治疗90 min、碳离子治疗120 min、复苏、拔管后的心率（HR）、平均动脉压（MAP）、血氧饱和度（SO₂）、经皮氧分压（tcpO₂）、经皮二氧化碳分压（tcpCO₂），以及自主呼吸状态及HFOV 状态膈肌头脚方向最大运动度；选取同期非HFOV 下碳离子治疗的42 例胸腹部恶性肿瘤患者为对照组，统计2组患者碳离子治疗的摆位误差及临床靶区至计划靶区的外放距离（MPTV），以及不良反应及处理。

结果

研究组33 例患者中，肺、肝脏肿瘤多为多个病灶，最多者24 个病灶，所有多病灶患者均一次完成治疗。患者治疗前后及治疗中HR、MAP 无差异（P＞0.05）；而患者治疗前SO₂、tcpO₂ 均低于其他阶段（P＜0.001）；复苏时及拔管后患者SO₂ 低于气管插管至碳离子治疗结束时水平，且高于治疗前（P＜0.001）；患者碳离子治疗90 min 和碳离子治疗120 min 时tcpO₂、tcpCO₂ 均高于其他阶段（P＜0.001），差异均有统计学意义。HFOV 时膈肌头脚方向最大运动度为1.30（0.80，2.00）mm，明显低于自主呼吸状态时的19.00（11.30，31.20）mm（P＜0.001）。研究组患者碳离子治疗的摆位误差为X 轴1.13（0.16，2.02）mm、Y 轴1.57（0.12，5.26）mm、Z 轴1.21（0.10，6.19）mm，对照组为X 轴1.23（0.98，2.85）mm、Y 轴2.52（1.27，3.51）mm、Z 轴1.64（0.73，3.08）mm，研究组摆位误差低于对照组，差异均有统计学意义（P＜0.001）。研究组患者MPTV 为X 轴1.13（0.70，1.47）mm、Y 轴1.57（0.89，2.41）mm、Z 轴1.21（0.74，1.61）mm，对照组患者MPTV 为X 轴1.22（1.15，1.29）mm、Y 轴2.51（2.04，2.66）mm、Z 轴1.63（1.49，1.75）mm，研究组MPTV 的Y 轴、Z 轴低于对照组，差异均有统计学意义（P＜0.001）；2组MPTV 的X 轴比较，差异无统计学意义（P＞0.05）。1 例患者发生高血压，1 例患者发生CO₂ 潴留。拔管后2 例患者出现恶心、呕吐，33 例患者中9 例发生放射性肺炎，其中1 级7 例，2 级2 例。

结论

HFOV 管控技术用于控制胸腹部肿瘤患者呼吸运动是安全的，可降低患者碳离子治疗时的摆位误差、缩小MPTV，使患者得到高剂量、更精准、副作用小的碳离子治疗，提高疗效。

Objective

To investigate the safety of high-frequency oscillatory ventilation (HFOV)control technique for controlling respiratory movement in patients with thoracic and abdominal tumors with carbon ion precision therapy.

Methods

A total of 33 patients with thoracic and abdominal malignant tumors who were hospitalized in Wuwei Cancer Hospital of Gansu Province from January 2023 to July 2024 and treated with carbon ion under the control of HFOV were selected as the study group.Heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SO₂), transcutaneous oxygen pressure (tcpO₂), transcutaneous carbon dioxide partial pressure (tcpCO₂) before treatment, after endotracheal intubation, 4D-CT positioning, target delineation for 30 min, 4D-CT reduction, carbon ion therapy for 30 min, 60 min, 90 min, 120 min, resuscitation,after extubation, and the maximum motion degree of diaphragm in the direction of head and foot in the state of spontaneous breathing and HFOV were statistically analyzed.42 patients with thoracic and abdominal malignant tumors treated with carbon ion therapy without HFOV were selected as the control group, and the positioning error, margin of planning target volume (MPTV), and adverse reaction and treatment of the two groups were analyzed.

Results

Most lung and liver tumors had multiple lesions, with a maximum of 24 lesions is 33 cases of the study group.All patients with multiple lesions were treated at one time.There were no significant differences in HR, MAP before, during, or after treatment (P＞0.05).SO₂, tcpO₂ were lower than those in other stages before treatment (P＜0.001).SO₂ was lower at resuscitation and after extubation than at the end of endotracheal intubation to carbon ion therapy, and higher than before treatment (P＜0.001).tcpO₂ and tcpCO₂ were higher than those in other stages after 90 minutes and 120 minutes of carbon ion treatment (P＜0.001).The maximum motion degree in the head and foot direction of the diaphragm in HFOV was 1.30 (0.80, 2.00) mm,which was significantly lower than that of 19.00 (11.30, 31.20) mm in the spontaneous breathing state (P＜0.001).The positioning errors of carbon ion therapy in study group were 1.13 (0.16, 2.02) mm on X-axis, 1.57 (0.12,5.26) mm on Y-axis and 1.21 (0.10, 6.19) mm on Z-axis.In the control group, the X-axis was 1.23 (0.98,2.85) mm, Y-axis was 2.52 (1.27, 3.51) mm, Z-axis was 1.64 (0.73, 3.08) mm, there were significant differences between the two groups (P＜0.001).The external boundary in the study group were 1.13 (0.70, 1.47) mm on the X-axis, 1.57 (0.89, 2.41) mm on the Y-axis, and 1.21 (0.74, 1.61) on the Z-axis mm, the external boundary of the control group was 1.22 (1.15, 1.29) mm on the X-axis, 2.51 (2.04, 2.66) mm on the Y-axis and 1.63 (1.49, 1.75)mm on the Z-axis, there were significant differences in the Y-axis and Z-axis of the external boundary between the two groups (P＜0.001), while there was no statistically significant difference in the X-axis of the external boundary between the two groups (P＞0.05).Hypertension occurred in 1 patient and CO₂ retention occurred in 1 patient.After extubation, 2 patients developed nausea and vomiting, 9 of 33 patients developed radiation pneumonia, in which 7 cases of grade 1 and 2 cases of grade 2.

Conclusion

The HFOV control technique is safe for controlling the respiratory movement of patients with thoracic and abdominal tumors.It can reduce the positioning error of patients during carbon ion therapy, narrow MPTV, and enable patients to get high-dose, more accurate and less side effects of carbon ion therapy, and improve the curative effect.