胸腔镜与开胸手术治疗创伤性血气胸及对应激因子、疼痛因子影响的对照研究

Comparative study of video-assisted thoracoscopic surgery and open thoracotomy for traumatic hemopneumothorax and its effect on stress factors and pain factors

目的研究胸腔镜(VATS)治疗创伤性血气胸(TH)及对应激因子、疼痛因子的影响。方法利用前瞻性对照研究分析。2014年6月-2019年5月内江市第一人民医院胸心外科收治TH患者116例,依据随机数字表法分为VATS组(58例)与开胸组(58例),VATS组行VATS术治疗,开胸组行开胸术治疗。观察两组手术相关指标及术后恢复指标,治疗1个月后肺功能指标,术前、术后7d疼痛因子、应激因子水平以及并发症。结果 VATS组切口长度、出血量、手术时间、止痛药物使用时间、胸腔引流时间、住院时间均少于开胸组(P <0. 05)。治疗1个月后,VATS组肺总容量(TLC)、用力肺活量(FVC)、呼气高峰流量(PEFR)、最大用力呼气中段流速(MMEF)、第1秒用力呼气量(FEV1)等肺功能指标均大于开胸组(P <0. 05)。术后7d,VATS组血清P物质(SP)、五羟色胺(5-HT)、血清去甲肾上腺素(NE)、皮质醇(Cor)、超氧化物歧化酶(SOD)、血管紧张素-2(AT-Ⅱ)水平均低于开胸组,SOD水平高于开胸组(P <0. 05)。VATS组并发症发生率(5. 17%)低于开胸组(17. 24%,P <0. 05)。结论 VATS治疗TH创伤小,恢复快,可有效改善患者肺功能,抑制分泌疼痛因子,缓解机体应激,并发症发生率低,有助于患者转归。

Objective To study the effect of video-assisted thoracoscopic surgery(VATS)on traumatic hemopneumothorax(TH)and its effect on stress factors and pain factors.Methods Totally 116 patients with TH who were admitted to the hospital from Jun.2014 to May 2019 were included in this study and divided into VATS group(n=58)and thoracotomy group(n=58)using random number table method.VATS treatment was given to patients in the VATS group,and thoracotomy treatment was given to patients in thoracotomy group.The operation and postoperative recovery indexes,lung function indicators at 1 month after treatment,the levels of pain factors and stress factors before and 7d after surgery in the two groups were observed.Complications in the two groups were observed.Results The incision length,blood loss,operation time,analgesic medication use time,chest drainage time,hospital stay time in the VATS group were less than those in the thoracotomy group(P<0.05).One month after treatment,TLC(total lung capacity),FVC(forced vital capacity),PEFR(peak expiratory flow rate),MMEF(maximal mid-expiratory flow curve),FEV1(forced expiratory volume in the first second)in the VATS group were higher than those in the thoracotomy group(P<0.05).At 7d after surgery,5-HT(5-hydroxytryptamine),SP(substance P),NE(noradrenaline),Cor(cortisol),SOD(superoxide dismutase),AT-II(angiotensinogen-II)in the VATS group were lower than those in the thoracotomy group,and SOD in the VATS group was higher than that in thoracotomy group(P<0.05).The incidence rate of complications in the VATS group(5.17%)was lower than that in the thoracotomy group(17.24%,P<0.05).Conclusion VATS treatment for TH has little trauma and rapid recovery,which can effectively improve patients lung function,inhibit the generation of pain factors and oxidative stress factors,and has low incidence of complications,which is conducive to patients recovery.