电视胸腔镜与开胸手术对老年多发性肋骨骨折并血胸患者肺功能及疼痛因子、炎性因子的影响

Effects of video-assisted thoracoscopy and thoracotomy on pulmonary function and pain factors in elderly patients with multiple rib fractures with hematothorax

目的研究电视胸腔镜(video-assisted thoracoscopic surgery,VATS)与开胸手术对老年多发性肋骨骨折并血胸(multiple rib fractures with hematothorax,MRF～HTX)患者肺功能及疼痛因子、炎性因子的影响。方法回顾性分析2014年7月—2018年6月河南省人民医院收治的118例因暴力导致的MRF～HTX患者的临床资料,依据治疗方法分为微创组(n=59)与开胸组(n=59)。其中男性75例,女性43例;年龄60～72岁,平均65.6岁;受伤至手术时间1～3d,平均时间1.6d。微创组行VATS治疗,开胸组行开胸手术治疗。观察两组手术时间、术中出血量、术后引流量、下床活动时间、疼痛缓解时间、住院时间;术后3、6个月第1秒用力呼气容积(forced expiratory volume 1,FEV1)、用力肺活量(forced vital capacity,FVC)肺功能指标;术前及术后7d血清P物质(serum P,SP)、五羟色胺(5-Hydroxytryptamine,5-HT)、去甲肾上腺素(norepinephrine,NE);肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-6(interleukin-6,IL-6)及术后并发症。结果微创组手术时间、术中出血量、术后引流量、下床活动时间、疼痛缓解时间、住院时间等均小于开胸组(P<0.05)。术后3、6个月,微创组FEV1、FVC等均大于开胸组(P<0.05);术后6个月,两组FEV1、FVC等均大于术后3个月(P<0.05)。术后7d,两组SP、5-HT、NE、TNF-α、IL-1β、IL-6均较术前减小(P<0.05),微创组SP、5-HT、NE、TNF-α、IL-1β、IL-6均小于开胸组(P<0.05)。微创组术后并发症发生率(6.78%)低于开胸组(18.64%,P<0.05)。结论 VATS应用于老年MRF-HTX患者具有创伤小、伤害性刺激弱等优势,可有效改善患者肺功能,减少疼痛因子及炎性因子,减少术后并发症发生。

Objective To study the effect of video-assisted thoracoscopic surgery(VATS)and thoracotomy on pulmonary function and pain factors,inflammatory factors in elderly patients with multiple rib fractures with haemothorax(MRF-HTX).Methods Totally 118 patients with MRF-HTX who were treated in Henan Provincial People s Hospital from Jul.2014 to Jun.2018 were analyzed retrospectively.They were divided into minimally invasive group(n=59)and thoracotomy group(n=59)according to the therapeutic method.There were 75 males(63.56%)and 43females(36.44%)with age of 60-72 years(average,65.6)years.Time from injury to operation was 1-3d(1.6)d.The minimally invasive group conducted VATS treatment,and the thoracotomy group conducted intrathoracic fixation treatment.The surgical indicators such as the time of operation,the amount of bleeding during surgery,the amount of drainage after surgery,the time of getting out of bed,the time of pain relief,and the time of hospitalization were observed.After operation,the pulmonary function indicators such as 3 and 6 months force exhalation volume 1(FEV1)and forced vital capacity(FVC)were observed.Preoperative and postoperative 7d serum P(SP),5-hydroxytryptamine(5-HT),norepinephrine(NE)and other pain factors,inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6)and postoperative complications were observed.Results The time of operation,bleeding volume,drainage volume,time of getting out of bed,pain relief time and hospitalization time of minimally invasive group were all less than those of the thoracotomy group(P<0.05).FEV1 and FVC 3 months and 6 months after operation in the minimally invasive group were all larger than those in the thoracotomy group(P<0.05).FEV1 and FVC of 6 months after operation in the two groups were all larger than those of 3 months(P<0.05)after operation.SP,5-HT,NE,TNF-α,IL-1β,IL-6 7d after operation in the two groups were all reduced compared to preoperatively(P<0.05).SP,5-HT,NE,TNF-α,IL-1β,IL-6 in the minimally invasive group were all less than those in the thoracotomy group(P<0.05).The incidence of postoperative complications in the minimally invasive group(6.78%)was lower than that in the thoracotomy group(18.64%,P<0.05).Conclusion VATS is minimally invasive and can improve pulmonary function,reduce pain factors and inflammatory factors,reduce postoperative complications,and promote patient recovery in elderly patients with MRF-HTX.