人工气胸在胸腔镜下胸腺切除术患者中的应用效果

Application Effect of Artificial Pneumothorax on Thoracoscopic Thymectomy

目的探讨人工气胸在胸腔镜下胸腺切除术患者中的应用效果。方法 2015年1-12月,便利抽样法选择在上海交通大学附属胸科医院住院治疗需行胸腔镜下胸腺切除术患者103例为研究对象。按随机数字表法将其分为观察组(n=56)和对照组(n=47),观察组患者在术中采用人工气胸技术,而对照组患者在术中不采用人工气胸技术。比较两组患者的手术指标(手术时间、术中出血量、中心静脉压、动脉血二氧化碳分压等)、手术情况(术中低血压发生情况及术中中转开胸情况)和并发症发生情况。结果与对照组患者相比,观察组患者手术时间短、术中出血量少,但是中心静脉压高、动脉血二氧化碳分压高,差异均有统计学意义(均P<0.01)。观察组中有7例患者发生术中低血压,1例患者因胸腔致密粘连中转开胸;对照组有2例患者发生术中低血压,2例患者因损伤左侧无名静脉而中转开胸,差异均无统计学意义(均P>0.05)。两组患者术中均未发生心跳骤停或其他严重并发症。结论胸腔镜胸腺切除术中采用人工气胸技术,可有效缩短手术时间、减少术中出血量。术前充分准备、术中严密监测及安全管理是手术成功的关键。

Objective To discuss the application effect of artificial pneumothorax on thoracoscopic thymec-tomy.Methods By convenience sampling,103 cases were selected and randomly divided into observation group （n=56）and control group （n=47）.The observation group was applied with artificial pneumotho-rax technology,but it was not applied in control group.The operation time,amount of bleeding,central venous pressure,CO2 partial pressure,and intraoperative hypotension or transfer to chest open surgery and incidence of complications of two groups were compared.Results Comparing with control group,the observation group was with short operation time,less amount of bleeding,but high central venous pres-sure,high partial pressure of carbon dioxide （all P〈0.01）.Seven cases had hypotension during surgery, 1 case got chest open because of intraperitoneal adhesion in observation group.Only 2 cases had hypoten-sion during surgery,and 2 cases got chest open because of brachiocephalic vein inj uries in control group （all P〉0.05）.There was no incidence of cardiac arrest or other serve implications.Conclusions The appli-cation of artificial pneumothorax can help shorten operation time and decrease blood loss.Full preparation before surgery,close observation during surgery and safety management are the keys of successful surgery.