胸膜剥脱术对结核性脓胸患者肺功能的影响

Effect of pleural decortication on the pulmonary function of patients with tuberculous empyema

目的:探讨胸膜剥脱术对结核性脓胸患者肺功能的影响。方法:对89例单纯结核性脓胸进行胸膜剥脱术,在患者术前、术后9个月进行血气分析检测,选取动脉血氧分压、动脉血二氧化碳分压、动脉血氧饱和度、p H 4项指标进行评价,并测定术前、术后3、6、9个月的肺功能指标,对第1秒用力呼气容积、用力肺活量及二者比值和最大通气量进行监测,了解肺功能变化情况。结果:所有患者手术顺利,术后恢复良好,术后9个月动脉血氧分压较术前改善明显(P<0.01),动脉血二氧化碳分压、动脉血氧饱和度和p H均无明显变化(P>0.05)。术后3、6、9个月肺功能监测指标均较术前明显改善(P<0.01),术后6个月和9个月各项肺功能指标亦均较术后3个月显著改善(P<0.01),而术后6个月和9个月差异均无统计学意义(P>0.05)。结论:胸膜剥脱术能够有效改善结核性脓胸的肺功能,6个月后基本恢复到最大限度,对于有手术指征的患者应尽早实施胸膜剥脱术,阻止胸廓进一步变形,达到最好的治疗效果。

Objective： To explore the effects of pleural decortication on the pulmonary function of patients with tuberculous empyema.Methods： Eighty-nine patients with tuberculous empyema were treated with pleural decortication. The levels of arterial oxygen tension,areterial carbon dioxide tension,arterial oxygen saturation and p H value in all cases were evaluated by blood gas analysis before operation and in 9 months after operation. The levels of forced vital capacity,forced expiratory volume in one second,FEV1 / FVC and maximal voluntary ventilarion in all cases before operation and in 3,6 and 9 months after operation were observed to investigate the lung function. Results： All operations were successful,and the postoperative recovery of patient was good. Compared with before operation,the arterial oxygen tension of patients were obviously improved（ P〈0. 01）,and the areterial carbon dioxide tension,arterial oxygen saturation and p H of patients were not obviously changed in 9 months after operation（ P〈0. 05）. The lung functions of patients in 3,6and 9 months after operation were significantly better than that in before operation（ P〈0. 01）,the lung functions of patients in 6 and 9months after operation were significantly better than that in 3 months after operation（ P〈0. 01）,the difference of lung function of patients between 6 and 9 months after operation was not statistical significance（ P〈0. 05）. Conclusions： Pleural decortication can effectively improve the lung function of patient with tuberculous empyema,the patient can better recovery in 6 months after operation.The pleural decortication can be early implemented for the patients with operation indication,which can prevent the further deformation of thorax.