27例肺减容术后激素治疗的探讨

The discussion of corticosteroid treatment of 27 pationts after lung volume surgery

目的探讨肺减容术(LVRS)后患者早期应用小剂量、短疗程激素治疗的临床意义。方法2007年5月27例慢性阻塞性肺疾病患者在我科行电视胸腔镜(VATS)辅助小切口单侧肺减容术,术后按是否给激素治疗分为激素与非激素治疗组,激素治疗组静脉给予地塞米松10mgtid,连续3d,然后改为强的松5mggd,连续7d后停药。结果术后两组漏气,时间差异无统计学意义(P>0.05);总胸腔引流量激素治疗组明显少于非激素治疗组(700±210mlvs,950±150ml,p=0.001);拔胸腔引流管时间激素治疗组较非激素治疗组早(9±3dVS,10±2d,p=0.005)。在术后1、3d时动脉血氧分压(PaO2)激素治疗组高于非激素治疗组(P<0.05),在第3、7d时白细胞计数激素治疗组略低于非激素治疗组,两组结果比较差异,无统计学意义(P<0.05),手术后早期两组均无并发感染和死亡患者。结论对肺减容术后患者短期内(本组为10d)使用小剂量激素治疗可以减轻胸膜炎症反应,减少胸腔引流量,缩短拔管时间,而不增加术后早期并发症的发生,同时对术后动脉血管的改善无明显影响。

Objective To investigate the clinical significance of low dose corticosteroid applied in early period after lung volume surgery （LVRS）. Methods From Jan 2001 to May 2007, 27patients with chronic obstructive pulmonary disease were undergone video-assisted unilateral LVRS assisted with mini-incision in our department were retrospectively reviewed. According to whether dispensed with postoperative corticosteroid or not, patients were divided into corticosteroid group and non-corticosteroid group. Corticosteroid group received dexamethasone 10mg iv tid for 3days and then declined to prednisone 5rag qd for 7days. Both groups were measured and compared the quantity of thoracic drainage flow, duration of chest tube drainage, the time air leaks and fever, and so on, At same time, blood gas analysis and blood routine test were performed at 1,3,7 and 30d after operation. Results Corticosteroid and non-corticosteroid groups had no statistically differences in the leaks time（P〉0,05）, but the quantity of thoracic drainage flow of corticosteroid group was lower than that of non-corticosteroid evidently （700±210ml vs 950±150ml, p=0.001）. There was significant difference in average duration of chest tube drainage between both groups （9±3d vs 13±2d, p=0.005）, Compared with non-corticosteroid group, PaO2 of corticosteroid group was higher at 1,3d after operation （P〈0,05）. The amount of blood leukocyte of corticosteroid group was lower than that of non-corticosteroid group at 3,7d after operation, there was no statistically significant in two groups （P〉0.05）. At early period after surgery, both groups had no significant infection and death patient, Conclusions The low dose corticosteroid applied in early period after LVRS for short time （10 days in this research） could shorten the duration of chest tube drainage, decrease the quantity of thoracic drainage flow and the extent of inflammation in pleural cavity. In the mean time, treatment dose not increase the occurrence of significant complications during the early postoperative period, and there is no negative influence to the blood gas analysis.