保留自主呼吸麻醉对肺大疱切除术患者呼吸的病理生理影响

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。

单、双孔胸腔镜肺大疱切除术治疗单侧自发性气胸患者的疗效比较

目的探究单、双孔胸腔镜肺大疱切除术治疗单侧自发性气胸患者的临床应用效果。方法 78例单侧自发性气胸患者,按照手术方案的不同分为单孔组与双孔组,各39例。双孔组实施双孔胸腔镜肺大疱切除术,单孔组实施单孔胸腔镜肺大疱切除术。(1)对比两组围术期基本情况,包括术中出血量、术后引流量、手术时间、留管时间及住院时间。(2)对比两组术后3 d、3个月、6个月的视觉模拟评分法(VAS)评分。(3)对比两组术前、术后7 d血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及白细胞介素-1(IL-1)水平。(4)对比两组并发症发生情况。结果两组手术时间比较,差异无统计学意义(P>0.05);单孔组留管时间及住院时间短于双孔组,术中出血量及术后引流量少于双孔组,差异均具有统计学意义(P<0.05)。单孔组术后3 d、3个月、6个月的VAS评分分别为(2.58±0.64)、(1.34±0.51)、(0.93±0.19)分,均低于双孔组的(4.79±0.82)、(2.26±0.63)、(1.16±0.48)分,差异均具有统计学意义(P<0.05)。术前,两组患者的血清CRP、TNF-α、IL-1水平比较,差异均无统计学意义(P>0.05);术后7 d,两组患者的血清CRP、TNF-α、IL-1水平均较本组术前降低,且单孔组降低程度优于双孔组,差异均具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(χ~2=1.412, P>0.05)。结论相较于双孔胸腔镜肺大疱切除术,单孔胸腔镜肺大疱切除术应用于单侧自发性气胸患者,可缩短恢复时间,缓解术后疼痛,促进炎症吸收。

An Exploration of the Treatment of Spontaneous Progressive Hemopneumothorax in Young People

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.