胸腔镜手术联合术后循环胸腔热灌注治疗脓胸的效果及对肺功能、炎症因子的影响

Efficacy of Thoracoscopic Surgery Combined with Postoperative Circulating Thoracic Perfusion on Empyema and Its Effect on Pulmonary Function,Inflammatory Cytokines

目的:研究胸腔镜手术联合术后循环胸腔热灌注治疗脓胸的效果及对肺功能、炎症因子的影响。方法:选择2016年3月—2019年2月期间在我院诊断为脓胸的患者56例,随机分为接受胸腔镜手术联合术后循环胸腔热灌注治疗的观察组,接受开放手术治疗的对照组。比较2组间手术情况、肺功能、血清炎症标志物、引流液细胞因子的差异。结果:观察组的手术时间及术后引流置管时间、术后抗生素使用时间均明显短于对照组,术中出血量、术后72h胸腔引流液量及术后引流液中白细胞介素(IL)-1β、IL-6、IL-8的含量明显少于对照组;2组手术后的肺活量(FVC)、每分钟最大通气量(MMV)、功能残气量(FRC)水平明显高于术前,血清中C反应蛋白(CRP)、降钙素原(PCT)的含量明显低于术前,且观察组术后的FVC、MMV、FRC水平明显高于对照组,血清中CRP、PCT的含量明显低于对照组。结论:胸腔镜手术联合术后循环胸腔热灌注治疗脓胸的效果优于开放手术且能改善术后肺功能、减轻术后炎症程度。

Objective:To study the efficacy of thoracoscopic surgery combined with postoperative circulating thoracic perfusion on empyema and its effect on pulmonary function,inflammatory cytokines.Methods:56 patients with empyema diagnosed in our hospital from March 2016 to February 2019 were randomly divided into two groups:the observation group receiving thoracoscopic surgery combined with postoperative circulatory thoracic perfusion therapy and the control group receiving open surgery.The differences of operation condition,pulmonary function,serum inflammatory markers and cytokines in drainage fluid between the two groups were compared.Results:The operation time,drainage time and antibiotic use time of the observation group were significantly shorter than those of the control group,the intraoperative bleeding volume,thoracic drainage volume with 72 hours after operation and the contents of interleukin(IL)-1β,IL-6 and IL-8 in the drainage fluid after operation were significantly less than those of the control group.The vital capacity(FVC),maximum ventilation volume(MMV)per minute and functional residual volume(FRC)of the two groups after operation were significantly higher than those before operation,C-reactive protein(CRP)and procalcitonin(PCT)contents in serum were significantly lower than those before operation and the levels of FVC,MMV and FRC in observation group were significantly higher than those in control group,while the CRP and PCT contents in serum were significantly lower than those in control group.Conclusion:The effect of thoracoscopic surgery combined with postoperative circulatory thoracic perfusion in the treatment of empyema is better than that of open surgery,which can improve the pulmonary function and reduce the degree of inflammation after operation.