急诊创伤性血气胸在床边超声引导下精准化穿刺置管引流术的治疗效果

Therapeutic effect of precise puncture and catheter drainage under bedside ultrasound guidance for emergency traumatic hemopneumothorax

目的分析急诊创伤性血气胸在床边超声引导下精准化穿刺置管引流术的治疗效果。方法选择该院2022年1月至2023年1月收治的急诊创伤性血气胸患者60例作为研究对象,采用随机数字表法将其分为对照组与观察组,每组30例。对照组患者接受传统胸腔封闭式引流术治疗,观察组患者接受床边超声引导下精准化穿刺置管引流术治疗。比较两组患者临床疗效、置管时间、操作时间、恢复情况[止痛药物使用量、置管引流量、置管引流时间和住院时间]、炎症因子[干扰素-γ(IFN-γ)、白细胞介素-1β(IL-1β)、细胞间黏附分子-1(ICAM-1)]水平、肺功能[第1秒用力呼气量(FEV_(1))、用力肺活量(FVC)、每分钟最大通气量(MVV)、残气量(RV)]及并发症发生情况。结果观察组临床总有效率为96.67%,高于对照组的73.33%,差异有统计学意义(P<0.05)。观察组患者的置管时间[(5.98±0.31)d]长于对照组[(3.57±0.24)d],而操作时间[(8.97±0.51)min]短于对照组[(11.28±0.47)min],差异均有统计学意义(P<0.05)。观察组止痛药物使用量和置管引流量小于对照组(P<0.05),置管引流时间和住院时间均短于对照组(P<0.05)。引流3 d,两组血清IFN-γ、IL-1β、ICAM-1水平低于术后即刻,且观察组血清IFN-γ、IL-1β、ICAM-1水平低于对照组,差异均有统计学意义(P<0.05)。术后1个月,两组FEV_(1)、FVC、MVV高于术前,而RV低于术前,差异均有统计学意义(P<0.05);观察组术后1个月FEV_(1)、FVC、MVV高于对照组,而RV低于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率为10.00%(3/30),低于对照组的36.67%(11/30),差异有统计学意义(P<0.05)。结论在床旁超声引导下精准化穿刺置管引流术治疗急诊创伤性血气胸,可以提升疗效,减轻术后炎症反应,改善肺功能,降低术后并发症发生率,利于患者早日康复。

Objective To analyze the therapeutic effect of precise puncture and catheter drainage under bedside ultrasound guidance for emergency traumatic hemopneumothorax.Methods Sixty patients with emergency traumatic hemopneumothorax diagnosed and treated in the hospital from January 2022 to January 2023 were selected and randomly divided into a control group and an observation group by random number table method,with 30 patients in each group.The control group received traditional closed thoracic drainage surgery,while the observation group received bedside ultrasound guided precise puncture and drainage surgery.The clinical efficacy,catheterization time and operation time,recovery status(amount of painkiller used,catheter drainage volume,catheter drainage time and hospitalization time),inflammatory factors[including interferon-γ(IFN-γ),interleukin-1β(IL-1β),intercellular adhesion molecule-1(ICAM-1)]levels,lung function[including first second forced expiratory volume(FEV_(1)),forced vital capacity(FVC),maximum minute ventilation volume(MVV),residual volume(RV)]and incidence of complications between the two groups were compared.Results The total clinical effective rate of the observation group was 96.67%,which was higher than 73.33%in the control group(P<0.05).The catheterization time of the observation group patients was longer than that of the control group,and the operation time was shorter than that of the control group,with statistically significant differences(P<0.05).The amount of painkillers used and the catheter drainage volume in the observation group were less than those in the control group(P<0.05),while the catheter drainage time and hospitalization time in the observation group were shorter than those in the control group(P<0.05).Drainage for 3 days,the levels of serum IFN-γ,IL-1βand ICAM-1 in both groups were all lower than those immediately after surgery,moreover,the levels of serum IFN-γ,IL-1βand ICAM-1 in the observation group were all lower than those in the control group,and the differences had statistical significance(P<0.05).One month after surgery,FEV_(1),FVC and MVV in both groups were higher than those before surgery,and RV in both groups was lower than that before surgery,with statistically significant differences(P<0.05);moreover,FEV_(1),FVC,and MVV in the observation group one month after surgery were higher than those in the control group,and RV was lower than that in the control group,with statistically significant differences(P<0.05).The incidence of complications in the observation group was 10.00%(3/30),which was lower than 36.67%(11/30)in the control group(P<0.05).Conclusion Ultrasound guided precise puncture and catheter drainage for bedside treatment of emergency traumatic hemopneumothorax can improve the efficacy,reduce postoperative inflammatory reactions,improve lung function,reduce the incidence of postoperative complications,and facilitate the early recovery of patients.