不同方案胸腔镜手术治疗自发性气胸疗效及对应激反应、疼痛介质影响

The choice of different schemes of thoracoscopy and its effect on the efficacy,stress response and pain mediator of spontaneous pneumothorax

目的探讨不同方案胸腔镜手术治疗自发性气胸疗效及对应激反应、疼痛介质的影响。方法选取自2020年2月至2022年2月收治的120例自发性气胸患者为研究对象,按手术方法分为常规组与观察组,每组60例。常规组实施传统的三孔胸腔镜治疗,观察组采取全肌肉分离单孔治疗。比较两组患者的围术期相关指标、治疗效果、疼痛情况、氧化应激反应、疼痛介质及不良反应。结果两组患者的治疗总有效率及术后并发症发生率比较,差异无统计学意义(P>0.05)。观察组患者的手术时间、住院时间、胸管引流时间、术中出血量及术后引流量均显著低于常规组,差异有统计学意义(P<0.05)。术前,两组视觉模拟评分法(VAS)、血清肾素(R)、肾上腺素(E)、血管紧张素Ⅱ(ACEIⅡ)、去甲肾上腺素(NE)、前列腺素E2(PGE2)、血清P物质(SP)、神经肽Y(NPY)比较,差异无统计学意义(P>0.05)。术后各时间点,两组VAS评分均下降,且观察组低于常规组,差异有统计学意义(P<0.05)。术后,两组R、E、ACEIⅡ、NE、PGE2、SP、NPY均明显升高,观察组明显低于常规组,差异有统计学意义(P<0.05)。结论相比三孔胸腔镜,单孔胸腔镜治疗自发性气胸患者可显著降低患者的氧化应激反应以及疼痛介质水平,效果良好。

Objective To explore the effect of thoracoscopic surgery on spontaneous pneumothorax and its influence on stress response and pain mediators.Methods A total of 120 patients with spontaneous pneumothorax admitted from February 2020 to February 2022 were selected as the research objects.According to the surgical method,they were divided into the conventional group and the observation group,with 60 cases in each group.The conventional group was treated with three-hole thoracoscopy,while the observation group was treated with a single hole separated by whole muscle.The perioperative indexes,therapeutic effect,pain,oxidative stress reaction,pain mediators and adverse reactions were compared between the two groups.Results There was no significant difference in the total effective rate and the incidence of postoperative complications between the two groups(P>0.05).The operation time,hospital stay time,chest tube drainage time,intraoperative blood loss and postoperative drainage volume in observation group were significantly lower than those in conventional group,with statistical significance(P<0.05).Before treatment,there was no significant difference in visual analogue scale(VAS)score,serum renin(R),epinephrine(E),angiotensinⅡ(ACEIⅡ),norepinephrine(NE),prostaglandin E2(PGE2),serum substance P(SP)and neuropeptide Y(NPY)between the two groups(P>0.05).After treatment,the VAS scores of both groups decreased,and the observation group was lower than that of the conventional group,the difference was statistically significant(P<0.05).After treatment,R,E,ACEIⅡ,NE,PGE2,SP and NPY were significantly increased in both groups,and those of the observation group were significantly lower than those of the conventional group,the difference were statistically significant(P<0.05).Conclusion Compared with three-hole thoracoscopy,single-hole thoracoscopy can significantly reduce the oxidative stress response and the level of pain mediators in patients with spontaneous pneumothorax,and the effect is good.