目的评估自主呼吸麻醉与双腔气管插管全身麻醉对肺大疱切除术(VATS)患者呼吸生理和气道炎症影响的研究。方法回顾性分析于2017年9月~2019年5月我院胸心外科行VATS手术的95例局限性肺大疱伴/不伴自发性气胸患者临床资料,根据麻醉方式分...目的评估自主呼吸麻醉与双腔气管插管全身麻醉对肺大疱切除术(VATS)患者呼吸生理和气道炎症影响的研究。方法回顾性分析于2017年9月~2019年5月我院胸心外科行VATS手术的95例局限性肺大疱伴/不伴自发性气胸患者临床资料,根据麻醉方式分为对照组(双腔气管插管全身麻醉下行VATS肺大疱切除术,52例)和观察组(自主呼吸静脉麻醉下行VATS肺大疱切除术,43例),比较两组术中、术后血气指标、炎症反应指标及术后恢复情况。结果两组患者术中及术后1h PaO 2、PaCO 2、血乳酸水平差异无统计学意义(P>0.05);术后12h及术后48h,观察组患者外周血白细胞数、中性粒细胞数、PCT水平均显著低于对照组,差异有统计学意义(P<0.05);观察组及对照组手术总时间[(65.6±15.7)min,(114.3±26.6)min,P<0.05],疼痛VAS评分[(2.5±0.8),(5.3±1.0),P<0.05];观察组术后进食早,抗生素使用时间及住院时间短,手术费用低,拔管时间差异均有统计学意义(P<0.05)。结论自主呼吸麻醉下VATS肺大疱切除术治疗肺大疱伴/不伴自发性气胸安全有效,与传统手术相比具有降低炎症反应、促进术后康复等优势,值得推广。展开更多
Objective:To explore an effective treatment for spontaneous progressive hemopneumothorax in young people.Methods:Thirty-four young patients with spontaneous progressive hemopneumothorax from January 2018 to December 2...Objective:To explore an effective treatment for spontaneous progressive hemopneumothorax in young people.Methods:Thirty-four young patients with spontaneous progressive hemopneumothorax from January 2018 to December 2019 were selected to be included in the control group for retrospective analysis;from January 2020 to December 2021,69 young patients with spontaneous progressive hemopneumothorax were selected to be included in the study group.The control group was treated with double-port thoracoscopic bullectomy,whereas the study group was treated with single-port thoracoscopic bullectomy.The intraoperative blood loss,operation time,tube retention time,VAS score,postoperative air leakage,and 1-year recurrence of the patients in the two groups were observed and analyzed.Results:The perioperative conditions of the patients in the study group,including intraoperative bleeding loss,operation time,tube retention time,and VAS scores,were 15.12±1.36,54.69±18.78,2.14±0.98,and 3.25±0.14,respectively.The perioperative conditions of the patients in the control group,including intraoperative bleeding loss,operation time,tube retention time,and VAS scores,were 22.69±2.01,55.36±19.01,4.21±1.01,and 5.36±0.45,respectively;other than the operation time,the differences in intraoperative blood loss,tube retention time,and VAS scores between the two groups were statistically significant(p<0.05);after the surgery,two patients in the study group had postoperative air leakage,accounting for 2.90%and another two patients had recurrence one year after the surgery,accounting for 2.90%;on the other hand,three patients in the control group had postoperative air leakage,accounting for 8.82%,and two patients had recurrence one year after the surgery,accounting for 5.88%.However,χ^(2) test showed that p>0.05.Conclusion:Treatment of spontaneous progressive hemopneumothorax in young people is better with single-port thoracoscopic bullectomy than with two-port thoracoscopic bullectomy,which effectively reduces intraoperative bleeding.The pain level is significantly better with single-port thoracoscopic bullectomy than with two-port thoracoscopic bullectomy,and the prognosis of patients is good with a low probability of recurrence for both,single-and twoport thoracoscopic bullectomy.展开更多
文摘目的评估自主呼吸麻醉与双腔气管插管全身麻醉对肺大疱切除术(VATS)患者呼吸生理和气道炎症影响的研究。方法回顾性分析于2017年9月~2019年5月我院胸心外科行VATS手术的95例局限性肺大疱伴/不伴自发性气胸患者临床资料,根据麻醉方式分为对照组(双腔气管插管全身麻醉下行VATS肺大疱切除术,52例)和观察组(自主呼吸静脉麻醉下行VATS肺大疱切除术,43例),比较两组术中、术后血气指标、炎症反应指标及术后恢复情况。结果两组患者术中及术后1h PaO 2、PaCO 2、血乳酸水平差异无统计学意义(P>0.05);术后12h及术后48h,观察组患者外周血白细胞数、中性粒细胞数、PCT水平均显著低于对照组,差异有统计学意义(P<0.05);观察组及对照组手术总时间[(65.6±15.7)min,(114.3±26.6)min,P<0.05],疼痛VAS评分[(2.5±0.8),(5.3±1.0),P<0.05];观察组术后进食早,抗生素使用时间及住院时间短,手术费用低,拔管时间差异均有统计学意义(P<0.05)。结论自主呼吸麻醉下VATS肺大疱切除术治疗肺大疱伴/不伴自发性气胸安全有效,与传统手术相比具有降低炎症反应、促进术后康复等优势,值得推广。
基金Baoding Science and Technology Planning Project(Project Number:1941ZF088)。
文摘Objective:To explore an effective treatment for spontaneous progressive hemopneumothorax in young people.Methods:Thirty-four young patients with spontaneous progressive hemopneumothorax from January 2018 to December 2019 were selected to be included in the control group for retrospective analysis;from January 2020 to December 2021,69 young patients with spontaneous progressive hemopneumothorax were selected to be included in the study group.The control group was treated with double-port thoracoscopic bullectomy,whereas the study group was treated with single-port thoracoscopic bullectomy.The intraoperative blood loss,operation time,tube retention time,VAS score,postoperative air leakage,and 1-year recurrence of the patients in the two groups were observed and analyzed.Results:The perioperative conditions of the patients in the study group,including intraoperative bleeding loss,operation time,tube retention time,and VAS scores,were 15.12±1.36,54.69±18.78,2.14±0.98,and 3.25±0.14,respectively.The perioperative conditions of the patients in the control group,including intraoperative bleeding loss,operation time,tube retention time,and VAS scores,were 22.69±2.01,55.36±19.01,4.21±1.01,and 5.36±0.45,respectively;other than the operation time,the differences in intraoperative blood loss,tube retention time,and VAS scores between the two groups were statistically significant(p<0.05);after the surgery,two patients in the study group had postoperative air leakage,accounting for 2.90%and another two patients had recurrence one year after the surgery,accounting for 2.90%;on the other hand,three patients in the control group had postoperative air leakage,accounting for 8.82%,and two patients had recurrence one year after the surgery,accounting for 5.88%.However,χ^(2) test showed that p>0.05.Conclusion:Treatment of spontaneous progressive hemopneumothorax in young people is better with single-port thoracoscopic bullectomy than with two-port thoracoscopic bullectomy,which effectively reduces intraoperative bleeding.The pain level is significantly better with single-port thoracoscopic bullectomy than with two-port thoracoscopic bullectomy,and the prognosis of patients is good with a low probability of recurrence for both,single-and twoport thoracoscopic bullectomy.