胸膜摩擦与滑石粉单用或联用固定对肺大疱微创切除术患者的影响研究

Impact of Single or Joint Use of Pleural Friction or Talcum Powder on Postoperative Patients Undergoing Pulmonary Bulla Minimally Invasive Resection

目的探究胸膜摩擦与滑石粉单用或联用固定对肺大疱微创切除术患者的影响。方法选取长沙市中心医院胸外科2013年8月—2014年8月收治的行肺大疱微创切除术患者180例,按治疗方法不同分为A组、B组及C组,每组60例。A组患者术中行胸膜摩擦固定,B组患者术中行滑石粉固定,C组患者术中行胸膜摩擦+滑石粉固定。比较3组患者围术期临床指标(手术时间、术后插管时间、住院时间及镇痛药物使用情况)和术后并发症发生情况。结果 3组患者术后插管时间比较,差异无统计学意义(P>0.05);B组患者手术时间短于A组和C组(P<0.05);A组患者住院时间长于B组和C组(P<0.05);C组患者镇痛药物使用频率高于A组和B组(P<0.05)。3组患者肺炎及肺不张发生率比较,差异无统计学意义(P>0.05);C组患者高热发生率高于A组和B组(P<0.05);A组患者胸腔积液和胸部残腔发生率均高于B组和C组(P<0.05)。结论肺大疱微创切除术患者术中行滑石粉单用固定可有效缩短手术时间,加快术后康复进程,且不增加术后并发症发生率,应用价值优于胸膜摩擦单用和胸膜摩擦与滑石粉联用。

Objective To investigate the impact of single or joint use of pleural friction or talcum powder on postoperative patients undergoing pulmonary bulla minimally invasive resection. Methods From August 2013 to August 2014,a total of 180 postoperative patients undergoing pulmonary bulla minimally invasive resection were selected in the Department of Chest Surgery,Changsha Centeral Hospital,and they were divided into groups A,B and C according to therapeutic methods,each of 60 cases. Patients of A group were given pleural friction only during surgery,patients of B group were given talcum powder only during surgery,while patients of C group were given pleural friction combined with talcum powder during surgery. Surgery duration,tracheal intubation time after surgery, hospital stays and usage of analgesic drugs and incidence of postoperative complications were compared among the three groups. Results No statistically significant differences of tracheal intubation time after surgery was found among the three groups（ P〈0. 05）; surgery duration of B group was statistically significantly shorter than that of A group,C group,respectively（ P〈0. 05）; hospital stays of A group was statistically significantly longer than that of B group,C group,respectively（ P〈0. 05）; the usage rate of analgesic drugs of C group was statistically significantly higher than that of A group,B group,respectively（ P〈0. 05）. No statistically significant differences of incidence of pneumonia or pulmonary atelectasis was found among the three groups（ P〈0. 05）; the incidence of hyperpyrexia of C group was statistically significantly higher than that of A group,B group,respectively（ P〈0. 05）; the incidence of pleural effusion and chest residual cavity of A group were statistically significantly higher than those of B group,C group,respectively（ P〈0. 05）. Conclusion Single use of talcum powder during surgery can effectively shorten the surgery duration,quicken the postoperative rehabilitation process of patients undergoing pulmonary bulla minimally invasive resection, without increasing the incidence of postoperative complications,has better clinical effect than single use of pleural friction or joint use of pleural friction and talcum powder.