碘伏对结核性脓胸手术患者术后炎性因子水平及深静脉血栓形成的影响

Effect of iodophor on postoperative inflammatory factors and deep venous thrombosis in patients with tuberculous empyema

目的探讨术中碘伏冲洗对结核性脓胸手术患者术后炎性因子水平与深静脉血栓形成(DVT)的影响。方法收集2020年1月至2021年1月河北省胸科医院收治的结核性脓胸手术患者的临床资料,将采用常规术中清洗的38例患者作为常规组,将采用碘伏术中冲洗的38例患者作为碘伏组。比较两组患者的术后恢复指标,包括引流管留置时间、术后疼痛程度、术后镇痛药物用量、住院时间。比较两组患者术后DVT与其他并发症的发生率。比较两组患者术前、术后3 d的凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)、血小板计数(PLT)]及血清炎性因子[白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平,以及术后3个月的肺功能指标[第1秒最大呼气容积与第1秒用力呼气量占用力肺活量百分比(FEV_(1)/FVC)]。结果碘伏组患者的引流管留置时间、住院时间均明显短于常规组患者,术后镇痛药物用量明显少于常规组患者,术后疼痛程度明显低于常规组患者,差异均有统计学意义(P<0.01)。碘伏组患者DVT、胸腔感染、切口愈合不良的发生率均低于常规组患者,差异均有统计学意义(P<0.05)。术后3 d,碘伏组患者的APTT、PT均明显长于常规组患者,D-D水平明显低于常规组患者,PLT明显低于常规组患者,差异均有统计学意义(P<0.01)。术后3 d,碘伏组患者的血清IL-8、TNF-α、CRP水平均低于常规组患者,差异均有统计学意义(P<0.01)。术后3个月,碘伏组患者的FEV_(1)、FEV_(1)/FVC均高于常规组患者,差异均有统计学意义(P<0.05)。结论结核性脓胸术中给予碘伏冲洗能够有效拮抗患者的炎性反应,促进患者术后恢复,降低DVT发生风险,改善患者的肺功能。

Objective To investigate the effect of intraoperative iodophor irrigation on postoperative inflammatory factor level and deep venous thrombosis(DVT)in patients with tuberculous empyema.Method The clinical data of patients with tuberculous empyema treated in Hebei Chest Hospital from January 2020 to January 2021 were collected.A total of 38 patients with routine intraoperative cleaning were used as the routine group,and 38 patients with intraoperative flushing with iodophor were used as the iodophor group.The postoperative recovery indexes of the two groups were compared,including the indwelling time of drainage tube,the degree of postoperative pain,the dosage of postoperative analgesic drugs and the length of hospital stay.The incidence of postoperative DVT and other complications were compared between the two groups.The coagulation function indexes[activated partial thromboplastin time(APTT),prothrombin time(PT),D-dimer(D-D),blood platelet(PLT)],serum inflammatory factor[interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)]levels and pulmonary function indexes[forced expiratory volume in one second(FEV_(1))/forced vital capacity(FVC)]3 months after operation were compared between the two groups.Result The indwelling time of drainage tube and hospital stay in iodophor group were significantly shorter than those in routine group,the dosage of postoperative analgesic drugs was significantly less than that in routine group,and the degree of postoperative pain was significantly lower than that in routine group(P<0.01).The incidence of DVT,thoracic infection and poor wound healing in iodophor group were lower than those in routine group(P<0.05).Three days after operation,APTT and PT in iodophor group were significantly longer than those in routine group,the level of D-D was significantly lower than that in routine group and PLT was significantly shorter than that in routine group(P<0.01).Three days after operation,the levels of serum IL-8,TNF-α,CRP were lower than those in the routine group(P<0.01).Three months after operation,FEV_(1) and FEV_(1)/FVC in iodophor group were higher than those in routine group(P<0.05).Conclusion Iodophor irrigation during operation of tuberculous empyema can effectively antagonize the inflammatory reaction,promote the postoperative recovery,reduce the risk of DVT and improve the pulmonary function of patients.