Effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery

Objective:The aim of this study was to observe the effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery.Methods:Forty patients of pulmonary carcinoma with video-assisted thoracic surgery were randomly assigned into two groups with twenty cases each:endobronchial blocker tube group(group 1) and double-lumen endobronchial tube group(group 2).After anesthesia was induced,in group 1,single lumen tube was intubated at first,and then endobronchial blocker tube intubated to left or right primary bronchus under the guidance of fiber-optic bronchoscope according to operational necessary,injected 2-4 mL air to blocker balloon and blocker one lateral primary bronchus for one-lung ventilation necessarily;while in group 2,the position of double-lumen endobronchial tube was confirmed with fiber-optic bronchoscope after intubation.Blood samples were collected before anesthesia induction,double lumen ventilation,at the one-lung ventilation of 5 min,30 min,60 min,120 min and 180 min,SBP,DBP,HR,SpO2,partial pressure of end tidal carbon dioxide(PetCO2),pH,PaO2,PaCO2,PaO2/FiO2 were recorded.Results:Forty cases' intubations were all successful.There were no differences in SBP,DBP,HR,SpO2,PetCO2,pH,PaCO2 between two groups in different points(P > 0.05).Paw in group 1 was lower than group 2,PaO2 and PaO2/FiO2 in group 1 was higher than group 2 in the one lung ventilation of 5 min,30 min,60 min,120 min and 180 min.Conclusion:The endobronchial blocker tube can meet the request of video-assisted thoracic surgery,with the special advantages of simple insertion,lower airway and better oxygenation.Endobronchial blocker tube offer a new way for one-lung ventilation in the pulmonary carcinoma with video-assisted thoracic surgery.

Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer

Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery （VATS） currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery （VATS） procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer （NSCLC） received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.

Case Report:Pulmonary actinomycosis:a case undergoing resection through video-assisted thoracic surgery (VATS)

Actinomycosis is an uncommon disease, which is usually manifested as cervicofacial infection; related to poor oral hygiene or compromised immune function. Pulmonary actinomycosis is rare, but its diagnosis is changing due to its variable presentation; the similarity in appearance to other intrapulmonary diseases. Here we report an 80-year-old man with a solitary pulmonary nodule over the left upper lobe. Pulmonary neoplasm was highly suspected in this patient; thus resection of the mass was undertaken through video-assisted thoracic surgery (VATS). Histopathological examination demonstrated this patient had an Actinomyeces infection. While the application of VATS in patients with pulmonary actinomycosis has rarely been reported in literature, we conclude that VATS is valuable for the diagnosis; treatment of patients with undetermined pulmonary nodule(s).

Video-Assisted Thoracic Surgery as a Less-Invasive Management for Acute Hemothorax in Blunt Trauma

Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-thoracotomy benefits for patients with blunt traumatic hemothorax compared with conventional repair through full thoracotomy. Twenty-five patients underwent emergency operation for acute hemothorax from 2000. Five patients with less than 5% probability of survival (PS) were excluded, leaving 20 as the subjects. Results: Ten patients underwent conventional thoracotomy (conventional group) and the other 10 patients underwent VATS with mini-thoracotomy (VATS group). There was no difference between conventional group and VATS group in injury severity score (29.1 and 27.0) or PS (81.2% and 80.7%). Hospital mortality rates were 10% in conventional group and 0% in VATS group (N.S). Total amounts of intra-operative bleeding and post-operative transfusion until day 7 were 735 ml and 19.3 units in conventional group and 303 ml and 9.2 units in VATS group respectively (N.S). The length of ICU stay was 9.7 days in conventional group and 5.9 days in VATS group (N.S). Conclusion: VATS with mini-thoracotomy can be alternative for patients with blunt traumatic hemothorax in most emergency operations.

Video-Assisted Thoracic Surgery for Residual Aneurysm after Total Arch Replacement

Background: Residual aneurysms after graft replacement are rare, but they can be detrimental if they are saccular and large. The etiology of residual aneurysms remains unknown, and their management is controversial. One treatment option is late open surgical conversion;however, postoperative respiratory complications resulting from the dissection of pleural adhesions, which is frequently necessary with this approach, are often unavoidable. Case presentation: Herein, we report a case of open surgical repair of a residual distal aortic arch aneurysm that occurred after total arch replacement and thoracic endovascular aortic repair. Contrast-enhanced magnetic resonance imaging was not possible in this case due to the patient’s severe renal dysfunction;however, contrast-enhanced computed tomography using minimal contrast did not detect remarkable leakage through the graft or stent graft into the aneurysm. Late open surgical conversion using video-assisted thoracic surgery was performed by thoracic surgeons, and the adhesion between the aortic wall and the lung was safely and effectively dissected. Because there was no significant pulsation or evidence of feeding arteries in the aortic wall, the aortic wall was opened carefully. No bleeding or backflow from any branch arteries into the aneurysm was noted, so the aortic wall was ligated with continuous sutures. The patient recovered without experiencing any major complications. Conclusions: This case report demonstrates that video-assisted thoracic surgery is safe and effective for late open conversion in cases of residual aneurysm;furthermore, this case suggests that video-assisted thoracic surgery may be particularly beneficial for the dissection of adhesions between the aortic wall and lung in these cases.

Uniportal Video-Assisted Thoracoscopic Surgery and Outcomes for Recurrent Primary Spontaneous Pneumothorax: Single-Institution Experience

Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.

Video-assisted Thoracoscopic Surgery for the Treatment of Mediastinal Lymph Node Tuberculous Abscesses

The mediastinal lymph node tuberculous abscesses（MLNTAs） are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery（VATS） for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment（ATT）, and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA.

Retrospective Comparative Analysis of Thoracic Empyema in Patients Older/Younger than 65

Objectives:Thoracic empyema is characterized by the collection of infected fluid/pus in the pleural space. A multitude of etiologies and surgical approaches exist. The current study aims to assess outcomes in elderly and young patients undergoing surgery for thoracic empyema. Methods: A retrospective comparative analysis was undertaken comparing outcomes in elderly and young patients undergoing surgery with an established diagnosis of empyema. Two groups were generated for comparison 1) patients older than 65 and 2) patients younger than 65. Demographics, comorbidities, post-operative complications, surgical approach and mortalities were compared between groups. Results: 526 patients underwent surgery for empyema during the study period (1993-2016). Group A (65) comprised 108 patients. With respect to group A, the median age at surgery was 45.30 years. Median post-operative stay was 10.50 days (9.10 vs. 11.90 in VATS and open respectively). 30-day mortality in group A was 1.90% (3.30% vs. 0.47% in VATS and open respectively). Group B comprised 108 patients (median age 72.70 years). Median post-operative stay was 14.40 days (11.20 vs. 17.8, VATS vs. open, p = 0.001). Overall 30-day mortality was 8.30 % (7.5% vs. 9% in VATS and open respectively, p = 0.03). Conclusions: The associated mortality and in-patient stay was significantly greater in elderly cohorts when compared to younger. Minimal access approaches confer a number of advantages in elderly patients including shorter hospital stay and reduced mortality.

机器人与胸腔镜肺段切除术治疗早期非小细胞肺癌疗效的对比研究

目的:对比分析达芬奇机器人与胸腔镜肺段切除术治疗早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效。方法:回顾性分析2016年06月至2020年12月,于我院胸外科行微创肺段切除术的早期非小细胞肺癌患者,共纳入134例,分为机器人组(robot-assisted thoracic surgery,RATS)47例,胸腔镜组(video-assisted thoracic surgery,VATS)87组,对比分析两组临床特征及手术指标、术后主要并发症情况及费用。结果:手术时间、术中出血、平均住院日、术后引流时间等,RATS组优于VATS组,但两组差异无统计学意义(P>0.05)。术后并发症如肺炎、胸腔积液、心律失常、肺不张发生率,两组间差异无统计学意义(P>0.05)。超过5天漏气率RATS组为6.3%,低于VATS组的10.3%,差异有统计学意义(P<0.05)。两组术后NRS疼痛评分差异无统计学意义(P>0.05)。RATS组住院费用明显高于胸腔镜组,差异有统计学意义(P<0.05)。两组1年生存率和2年生存率差异均无统计学意义(P>0.05)。结论:机器人肺段切除术治疗早期非小细胞肺癌安全可行,与胸腔镜相比,术后长期漏气发生较少,值得推广应用。

Primary pneumothorax:Should surgery be offered after the first episode?

Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax(PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracicsurgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.

电视胸腔镜与传统开胸手术治疗创伤性血胸的效果比较

目的探讨电视胸腔镜与传统开胸手术治疗创伤性血胸的效果与安全性。方法选取2021年3月—2023年8月武警山西总队医院确诊为创伤性血胸的82例患者,依据入院时间顺序分为2组,各41例。对照组行传统开胸手术处理,观察组行电视胸腔镜手术治疗。比较2组手术处理效果及安全性。结果观察组手术时间、术后胸腔引流时间、术后镇痛用药时间以及住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后24 h,观察组皮质醇(cortisol,Cor)、神经肽Y(neuropeptideY,NPY)以及P物质(substance P,SP)的检测值均低于对照组,差异有统计学意义(P<0.05);观察组患者术后12 h以及术后第1、2、3天的疼痛程度评分均低于对照组,差异有统计学意义(P<0.05);观察组术后并发症总发生率为7.32%,低于对照组的24.39%,差异有统计学意义(P<0.05)。结论电视胸腔镜手术用于创伤性血胸的治疗效果确切,并可减轻创伤应激反应及术后疼痛程度,减少并发症发生,效果优于传统开胸手术。

不同剂量艾司氯胺酮联合罗哌卡因前锯肌平面阻滞对胸腔镜手术病人术后镇痛的影响

目的评价不同剂量艾司氯胺酮联合罗哌卡因前锯肌平面阻滞(SAPB)对胸腔镜手术病人术后镇痛的影响。方法选择择期行胸腔镜手术病人96例,随机分为单纯罗哌卡因组(A组,SAPB局麻药为5 g/L罗哌卡因30 mL)、0.25 mg/kg艾司氯胺酮组(B组,在5 g/L罗哌卡因的基础上加用0.25 mg/kg艾司氯胺酮)、0.50 mg/kg艾司氯胺酮组(C组,在5 g/L罗哌卡因的基础上加用0.50 mg/kg艾司氯胺酮)。记录术后2、6、12、24、48 h时的数字等级评定量表(NRS)评分,术后48 h吗啡用量,术后首次按压静脉自控镇痛(PCIA)装置时间,术后需要PCIA病人比例,术中舒芬太尼的用量及不良反应发生情况。结果与A组相比较,C组术后12、24 h NRS评分均显著降低(H=9.006、8.785,P<0.05),术后48 h吗啡用量减少(H=7.400,P<0.05),首次按压PCIA时间明显延长(P<0.05)。3组需要PCIA病人比例和术中舒芬太尼用量差异无统计学意义(P>0.05)。3组不良反应发生率差异无统计学意义(P>0.05)。结论与单纯应用罗哌卡因相比,0.50 mg/kg艾司氯胺酮联合罗哌卡因SAPB用于胸腔镜手术病人可增强术后镇痛效果,减少术后48 h吗啡用量,延长SAPB镇痛持续时间,且无明显不良反应。

胸腔镜下肺段切除术治疗犬肺血管肉瘤

与传统手术方式相比,内窥镜手术对动物损伤较小,具有术后动物出血量少、疼痛轻、组织黏连少、恢复快等优点,已被广泛应用于国内外兽医临床。然而,胸腔镜手术因难度大、术后并发症多等在我国兽医临床较少实施。本文从病例基本情况、检查、诊断以及手术过程等方面,详细介绍了用胸腔镜成功为一例罹患肺转移性血管肉瘤的10岁金毛犬施行部分肺叶切除术的案例,并且分析了电视胸腔镜手术的设备器械选择、单肺气体插管方法,以及胸腔镜手术需要注意的一些细节,以期为同行开展兽医临床胸腔镜手术提供参考。

肺癌患者胸腔镜肺切除术后闭式引流切口愈合不良影响因素分析

目的探讨肺癌患者胸腔镜肺切除术后闭式引流切口愈合不良的影响因素,为临床干预提供依据。方法选取2022年1月1日至2023年12月31日经病理诊断为肺癌并行胸腔镜肺切除术的704例患者为研究对象。根据是否发生闭式引流切口愈合不良将患者分为愈合不良组(128例)和愈合组(576例)。对可能影响患者术后闭式引流切口愈合不良因素,如性别、年龄、体质量指数(body mass index,BMI)、其他既往史(手术侧乳腺癌根治性切除术史、免疫系统疾病)、高血压、糖尿病、吸烟史、手术时间、切除范围、闭式引流位置、引流管切口缝合针数、留置引流管时间、引流管口拆线时间、术前白蛋白水平进行单因素分析及多因素Logistic回归分析。结果单因素分析结果显示,年龄、BMI、糖尿病与发生闭式引流切口愈合不良有关(P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=1.615,95%CI:1.081~2.413,P=0.019)、BMI(OR=2.086,95%CI:1.382~3.148,P<0.001)、糖尿病(OR=2.103,95%CI:1.216~3.638,P=0.008)是闭式引流切口愈合不良独立危险因素。结论年龄、BMI、糖尿病是肺癌患者行胸腔镜术后闭式引流切口愈合不良的独立危险因素,医护人员应重点关注,围手术期做好准备工作,术后关注伤口变化,给予针对性措施,以减少闭式引流切口愈合不良的发生。

叶内型肺隔离症合并肺隐球菌病1例并文献复习

报道1例52岁男性叶内型肺隔离症合并肺隐球菌病患者,因咳嗽、咳痰和胸闷入院,胸部CT显示右下肺脊柱旁有1个椭圆形肿块,左下肺有1个结节。CT引导下经皮肺活检证实右下肺肿块为肺隔离症,左下肺结节为隐球菌感染。行电视辅助外科胸腔镜手术切除肺隔离叶,通过口服氟康唑治疗患者左下肺隐球菌结节。术后3年定期随访,增强CT示左下肺隐球菌结节消失,右下肺隔离症术后良好。该文总结了1例肺隔离症合并隐球菌病的临床表现、治疗及转归,旨在提高临床医师对该病的认识。

胸腔镜手术视频在临床解剖教学中的应用探索

目的探讨胸腔镜手术视频在临床解剖教学中的应用效果。方法于2022年11—12月选取中山大学医学院2020级临床医学五年制本科生两个大班的129名学生为研究对象,按照随机分配法则分为试验组和对照组,其中试验组66名,对照组63名。对照组采用传统临床解剖教学法,试验组采用胸腔镜手术视频结合传统临床解剖教学方式。比较2组的理解教学目的、教学内容丰富、教学重点突出、有利于提高对胸部解剖课程的兴趣、教学方式满意度、对胸部相关临床知识有所了解、愿意深入了解胸部疾病相关知识、对胸部解剖相关知识的掌握程度、对胸部解剖基本技能掌握程度评分以及课程总体评分,总结学生对本课程的印象、意见和建议。结果试验组收集有效问卷49份,对照组收集有效问卷52份。试验组的教学重点突出[(4.80±0.46)分]、对胸部相关临床知识有所了解[(4.76±0.48)分]、对胸部解剖相关知识的掌握程度[(4.51±0.68)分]评分高于对照组[(4.46±0.94)分、(4.19±1.12)分、(4.08±1.21)分],差异有统计学意义(P<0.05)。试验组29名学生反映“喜欢带有临床知识的课程”“临床手术视频很清晰,对理论理解更深刻”“挑选的素材很用心,对胸部的解剖结构有了较深刻的理解”“授课方式很生动”“授课方式值得提倡”“希望以后多采用基础知识结合临床实际案例授课”;同时,2名学生觉得“手术对于本科生有点难”“手术视频中的神经难看清,结构不易区分”。对照组22名学生感觉“老师讲得很好”“课程不错”,3名学生建议“希望老师多讲基础知识和理论”“展示解剖操作的具体步骤和需要观察学习的内容”。结论胸腔镜手术视频结合传统解剖教学的模式能有效提高胸部临床解剖教学质量及学生对临床的兴趣,适用于临床解剖教学。

胸腔镜肺癌根治术后继发乳糜胸诊疗的研究进展

乳糜胸常见于胸导管或其分支损伤,是一种电视辅助胸腔镜手术(VATS)肺癌根治术后较严重的并发症。乳糜胸的早期诊断对于改善患者预后至关重要,需综合患者临床资料进行动态评估。关于乳糜胸的治疗主要包括保守治疗、介入治疗以及外科手术治疗,保守治疗是VATS肺癌根治术后乳糜胸的首选治疗方式。对于持续大量乳糜排出以及病程较长的患者,应在其出现严重并发症前及时行介入或外科手术干预。目前尚缺乏方法学上可靠的临床试验指导VATS肺癌根治术后乳糜胸患者的管理,未来全面了解VATS肺癌根治术后乳糜胸的诊疗策略,可以为疾病的治疗提供新思路。

口服普瑞巴林对胸腔镜手术患者术后睡眠的影响

目的 观察术后口服普瑞巴林对电视辅助胸腔镜手术(VATS)患者术后睡眠的影响。方法 择期全麻下行VATS的患者120例,随机分为75 mg普瑞巴林组(A组)、150 mg普瑞巴林组(B组)和安慰剂组(C组),每组40例。于手术当晚、术后第1天和第2天早晚,3组患者分别口服普瑞巴林1粒和形状气味相同的安慰剂1粒、普瑞巴林2粒以及安慰剂2粒。手术当晚采用雅典失眠量表(AIS)评估患者术后睡眠障碍(PSD)发生率,采用St. Mary's医院睡眠问卷(SMH)评估患者术前至术后第2天的每夜睡眠质量,术前1 d、术后7 d和1个月,采用匹兹堡睡眠质量指数(PSQI)评估患者术前和术后的睡眠情况,采用数字疼痛评分(NRS)评估患者术后切口和肩部疼痛;记录补救镇痛情况、术后72 h内不良反应的发生情况以及患者满意度评分。结果 A、B、C组患者PSD发生率分别为45.0%,42.5%,72.5%;A组、B组均明显低于C组(分别与C组两两比较,P <0.0167)。术后3 d,A组、B组SMH评分明显高于C组(分别与C组两两比较,P <0.0167)。术后第1、第2天,A、B两组切口处NRS评分和术后补救镇痛发生率显著低于C组(分别与C组两两比较,P <0.0167);其余时间点,3组患者切口处和肩部疼痛评分差异无统计学意义(P> 0.05)。A组、B组术后患者满意度评分明显高于C组(P <0.01)。B组头晕发生率明显高于A、C两组(P <0.0167)。结论 VATS术后连续3 d口服普瑞巴林可降低患者PSD发生率,改善睡眠质量,但150mg普瑞巴林可能增加头晕发生率。

胸腔镜下叶肺癌手术引流管留置不同深度临床效果对比

目的分析胸腔镜下叶肺癌手术胸腔引流管留置不同深度的临床效果。方法选择2022年6月至2023年12月我科收治的下叶肺癌患者90例,行单操作孔胸腔镜肺下叶切除+淋巴结清扫,术后经观察孔留置单一28号硅胶引流管,按照住院号随机分为观察组、对照组各45例,观察组胸腔引流管留置深度5~6 cm,对照组10~14 cm,对2组试验对象的引流量、引流时间、住院时间、肺不张、胸腔积液发生率、术后第1~3天疼痛评分等进行统计比较。结果观察组与对照组的引流量[(707±137)ml与(764±159)ml,t=-1.793,P=0.076]、引流时间[(4.0±0.8)与(4.2±0.8),t=-1.619,P=0.109]、术后住院时间[(8.8±1.1)与(9.0±1.3),t=-0.704,P=0.483]比较差异均无统计学意义(P>0.05);观察者与对照组术后肺不张发生率[3/45与5/45,χ^(2)=0.549,P=0.357]、胸腔积液发生率(6/45与4/45,χ^(2)=0.450,P=0.370),差异均无统计学意义(P>0.05);观察组与对照组术后胸痛评分比较,第1天[(6.6±1.1)分与(7.9±1.1)分,t=-5.648,P<0.001],第2天[(5.2±0.8)分与(6.2±0.7)分,t=-5.606,P<0.001],第3天[(3.9±0.9)分与(4.7±0.7)分,t=-4.428,P<0.001],差异均有统计学意义(P<0.05)。结论对于下叶肺癌行单操作孔胸腔镜肺下叶切除病例,经观察孔放置深度较短的引流管可以降低术后胸痛程度,且引流效果不会受到影响。

罗哌卡因复合纳布啡行胸椎旁神经阻滞对胸腔镜手术患者术后急性疼痛和恢复质量的影响

目的探讨罗哌卡因复合纳布啡行胸椎旁神经阻滞(TPVB)对胸腔镜手术(VATS)患者术后急性疼痛以及恢复质量的影响。方法选择2023年8月-2024年2月本院收治的全麻下行VATS的60例患者作为研究对象,随机分为单纯罗哌卡因椎旁神经阻滞组(C组)与罗哌卡因复合纳布啡组(N组)两组,每组各30例。C组给予0.40%的罗哌卡因30 ml,N组给予0.40%的罗哌卡因+纳布啡20 mg共30 ml。分别记录术后1 h、3 h、6 h、12 h、24 h、48 h时刻静息和动态视觉模拟(VAS)评分,术后24 h内口服吗啡当量(OME)使用量,PCIA次数和补救性镇痛次数;记录术前、术后第1 d的15项恢复质量评分(QoR-15)和住院时间;记录术后24 h不良反应的发生率。结果与C组相比,N组术后6 h、12 h、24 h静息与运动状态下VAS评分均降低(P<0.05);与C组相比,N组术后OME降低(P<0.05),QoR-15评分更高(P<0.05);两组患者在PCIA次数、补救性镇痛次数、住院时间和术后不良反应发生率经比较,差异无统计学意义(P>0.05)。结论纳布啡作为TPVB中罗哌卡因的佐剂可减轻VATS术后急性疼痛,有效减少术后镇痛药物使用,可以提高患者术后恢复质量,且无明显的不良反应。