闭合式纤维板剥脱术联合肺叶裂游离术对慢性脓胸患者肺功能及动脉血气指标的影响

Effect of pleural fibreboard peeling combined with pulmonary lobectomy on pulmonary function and arterial blood gas index in patients with chronic empyema

目的探讨闭合式纤维板剥脱术联合肺叶裂游离术对慢性脓胸患者肺功能及动脉血气指标的影响。方法选取2018年2月至2020年8月本院收治的75例慢性脓胸患者患者作为研究对象,按照随机数字表法分为对照组(n=37)与观察组(n=38)。对照组行单纯闭合式纤维板剥脱术,观察组行闭合式纤维板剥脱术联合肺叶裂游离术,比较两组临床疗效、围手术期指标、手术前后肺功能指标[肺活量(VC)、每分钟最大通气量(MVV)、最大呼气量(PEF)、第1秒用力呼气容积占预计值百分比(FEV_(1)%)]及动脉血气指标[动脉血氧分压(PaO_(2))、动脉血氧饱和度(SpO_(2))、动脉血二氧化碳分压(PaCO_(2))、pH]、并发症发生率。结果观察组治疗总有效率为100.00%,高于对照组的83.78%,差异有统计学意义(P<0.05)。观察组手术时间长于对照组,术中出血量、术后24h引流量均多于对照组,差异有统计学意义(P<0.05);两组术后住院时间、带管时间比较差异无统计学意义。术前,两组VC、MVV、PEF、FEV_(1)%水平比较差异无统计学意义;术后6个月,两组VC、MVV、PEF、FEV_(1)%水平均高于术前,且观察组明显高于对照组,差异有统计学意义(P<0.05)。术前,两组PaO_(2)、SpO_(2)、PaCO_(2)、pH水平比较差异无统计学意义;术后6个月,两组PaO_(2)、PaCO_(2)水平均高于术前,且观察组PaO_(2)高于对照组,差异有统计学意义(P<0.05),两组SpO_(2)、PaCO_(2)、pH水平比较差异无统计学意义。两组并发症发生率比较差异无统计学意义。结论闭合式纤维板剥脱术联合肺叶裂游离术治疗慢性脓胸效果确切,可改善患者肺功能及动脉血氧分压,促进肺组织复张,值得临床推广应用。

Objective To investigate the effect of pleural fibreboard peeling combined with pulmonary lobectomy on pulmonary function and ar-terial blood gas index in patients with chronic empyema.Methods 75 patients with chronic empyema admitted to our hospital from February 2018 to August 2020 were selected as the research subjects,and they were divided into the control group(n=37)and the observation group(n=38)accord-ing to random number table method.The control group was treated with simple pleural fiberboard peeling,while the observation group was treated with pleural fiberboard peeling combined with pulmonary lobectomy,the clinical efficacy,perioperative indicators,pulmonary function indicators(vital capacity[VC],maximum ventilation per minute[MVV],maximum expiratory volume[PEF],percentage of forced expiratory volume in the first second to the expected value[FEV_(1)%])and arterial blood gas indexs(arterial partial pressure of oxygen[PaO_(2)],arterial oxygen saturation[SpO_(2)],partial pressure arterial blood of carbon dioxide[PaCO_(2)],pH)before and after operation,and incidence of complications were compared between the two groups.Results The total effective rate in the observation group was 100.00%,which was higher than 83.78%in the control group,and the dif-ference was statistically significant(P<0.05).The operation time in the observation group was longer than that in the control group,and the intraop-erative bleeding and the 24 h postoperative drainage volume were more than those in the control group,and the differences were statistically significant(P<0.05);there were no significant differences in postoperative hospitalization time and catheterization time between the two groups.Before operation,there were no significant differences in the levels of VC,MVV,PEF and FEV_(1)%between the two groups;6 months after operation,the levels of VC,MVV,PEF and FEV_(1)%of the two groups were higher than those before operation,and the observation group was higher than the control group,and the differences were statistically significant(P<0.05).Before operation,there were no significant differences in the levels of PaO_(2),SpO_(2),PaCO_(2) and pH between the two groups;6 months after operation,the levels of PaO_(2),PaCO_(2) of the two groups were higher than those before operation,and the level of PaO_(2) in the observation group was higher than that in the control group,and the differences were statistically significant(P<0.05),while there were no statistically significant differences in the levels of SpO_(2),PaCO_(2) and pH between the two groups.There was no significant difference in the incidence of complications between the two groups.Conclusion Pleural fiberboard peeling combined with pulmonary lobectomy is effective in the treatment of chronic empyema,which can improve pulmonary function and arterial oxygen partial pressure and promote pulmonary tissue recruitment,and is worthy of clinical promotion and application.