The Application of Forward Control Nursing in Anesthesia, Recovery, and Rehabilitation of Thoracoscopic Lung Cancer Radical Surgery

Objective: To explore the clinical application effect of formulating the operating room nursing work procedure sheet for elderly lung cancer patients in thoracoscopic radical surgery. Methods: A total of 85 elderly patients with lung cancer treated in our hospital from May 2022 to May 2023 were included as the study population for this research. They were divided into a study group of 42 cases and a regular group of 43 cases. The regular group of elderly patients received routine nursing care, while the study group of elderly patients was provided with the operating room nursing care work procedure sheet. The surgical duration, intraoperative blood loss, time to mobilization, and postoperative complication rate were compared and analyzed between the two groups. Results: Compared to the regular group, the study group had significantly shorter surgical duration and time to mobilization, as well as less intraoperative blood loss (P < 0.05). The overall incidence of postoperative complications in the study group (4.76%) was significantly lower than that in the regular group (19.05%) (P Conclusion: Formulating the operating room nursing work procedure sheet for elderly lung cancer patients can effectively improve surgical efficiency, reduce the incidence of postoperative complications, and promote patient prognosis in thoracoscopic radical surgery. Therefore, this model is worth promoting and adopting in clinical practice.

Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer

Objective： The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery （VATS） radical treatment for patients with stage ⅢA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. Methods： A total of 51 patients with radiologically or mediastinoscopically confirmed stage ⅢA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/ complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. Results： A total of 51 patients with non-small cell lung cancer （NSCLC） were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 （80.4%） had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 （98%） received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage （〉1,000 mL）, and the postoperative recovery was satisfactory. Up to 45 patients （88.2%） did not suffer from any perioperative complication, and 6 （11.8%） experienced one or more complications. Conclusions： VATS radical treatment is a safe and feasible treatment for stage ⅢA lung cancer.

Comparison of the body pain and trauma degree between uni-portal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer

Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-small cell lung cancer who received radical operation in our hospital between February 2013 and February 2016 were selected and divided into the uniportal group (n=52) who received uniportal video-assisted thoracoscopic surgery and the three-portal group (n=56) who received three-portal video-assisted thoracoscopic surgery after the operation methods and related laboratory results were reviewed. Before operation and 24 h after operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were compared between the two groups of patients.Results: Before operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were not statistically significant between the two groups of patients. 24 h after operation, serum pain mediators NE, DA and 5-HT levels of observation group were lower than those of control group;oxidative stress indexes MDA and O2- levels were lower than those of control group while SOD and GSH-Px levels were higher than those of control group;inflammation indexes IL-6, IL-8, CRP and TNF-α levels were lower than those of control group.Conclusion: Uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer causes less surgery trauma, and patients' postoperative pain and systemic inflammatory stress response are lighter.

Clinical Practice of Evidence-Based PDCA Cycle Management Model in Accelerated Recovery of Lung Cancer Patients

Objective: To explore the nursing effect of evidence-based PDCA cycle management mode in accelerated rehabilitation of patients undergoing thoracoscopic lung cancer radical surgery. Methods: 104 patients who underwent thoracoscopic lung cancer radical surgery in our hospital from June 2022 to February 2023 were randomly divided into control group and intervention group, with 52 cases in each group. The control group implemented evidence-based ERAS clinical pathway management, while the intervention group implemented evidence-based PDCA cycle quality management. The postoperative recovery of the two groups of patients was compared. Results: The postoperative recovery of the intervention group was significantly better than that of the control group. The first time to get out of bed, the first time to eat, the duration of chest drainage tube placement, and the length of hospital stay were significantly shorter than those of the control group. The incidence of postoperative chest complications and hospitalization costs were significantly lower than those of the control group, and patient satisfaction was significantly higher than that of the control group (P Conclusion: Evidence-based PDCA cycle quality management mode can effectively improve the implementation quality of accelerated rehabilitation nursing for patients undergoing thoracoscopic lung cancer radical surgery, and it is worthy of clinical promotion.

Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer

Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods： Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results： Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients （69%）. The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions： VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC

Robot-assisted lobectomy in a patient with poor lung function:Another advantage of robot-assisted thoracoscopic surgery

Patients with poor lung function have a high-risk for pulmonary complications following lobectomy.The development of minimally invasive thoracic surgical techniques allows sicker patients to safely undergo lung resection.Robotic lobectomy could benefit these higher risk patients.Here we present a case of a 58-year-old female patient with poor lung function presented with a 3-cm mass in her lower left pulmonary lobe,who successfully underwent lobectomy via robot-assisted thoracoscopic surgery.Her forced expiratory volume in one second was slightly improved compared to the preoperative value.Her forced vital capacity continued to improve in the follow-up period.There was no recorded recurrence during the three years follow-up period.

Clinical experiences with 20 cases of single-direction thoracoscopic lobectomy and systematic lymph node dissection for peripheral NSCLC

Objective: To evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. Methods: From December 2009 to March 2011, 20 patients with peripheral lung cancer were treated with single-direction thoracoscopic lobectomy and systemic lymph nodes dissection. Results: Surgeries were successfully performed. No significant complications occurred perioperatively. The average operation time was 193 min, the average blood loss was 234 ml, the average duration of drainage was 6 d, the postoperative hospital stay was 12 d, and the average number of lymph nodes dissected was 16. Conclusion: Single-direction thoracoscopic lobectomy is feasible and safe in the treatment of peripheral lung cancer and can simplify the surgical procedures.

Advances and controversies in the management of early stage nonsmall cell lung cancer

Complete resection continues to be the gold standard for the treatment of earlystage lung cancer.The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer,as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy.There is a growing tendency to perform sublobar resection in selected cases,as,depending on factors such as tumor size,histologic subtype,lymph node involvement,and resection margins,it can produce similar oncological results to lobectomy.Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.

六字诀对快速康复外科非小细胞肺癌胸腔镜肺叶切除术后病人肺癌术后症状及并发症的影响

目的:观察六字诀对快速康复外科(ERAS)非小细胞肺癌(NSCLC)胸腔镜肺叶切除术后病人肺癌术后症状及并发症发生情况的影响。方法:选取2021年6月—2022年4月入院诊断为NSCLC并行快速康复外科胸腔镜肺叶切除术后病人101例作为研究对象,采用随机数字表法随机分成对照组(n=50)和六字诀组(n=51)。对照组采用快速康复外科常规治疗与护理,六字诀组在对照组的基础上进行12周六字诀训练,于干预前后评估病人肺癌术后症状、中性粒细胞与淋巴细胞比以及血小板与淋巴细胞比(NLR、PLR)和并发症发生情况。结果:干预后六字诀组肺癌术后咳嗽症状改善较对照组显著,差异有统计学意义(P<0.05)。六字诀组肺癌术后并发症发生率与对照组比较差异无统计学意义(P>0.05)。结论:六字诀可有效改善ERAS非小细胞肺癌胸腔镜肺叶切除术后病人的咳嗽症状。

胸腔镜微创手术治疗老年肺癌的效果及对患者术后肺功能的影响研究

探讨胸腔镜微创手术治疗老年肺癌患者的效果及对其术后肺功能的影响。选取2020年8月—2023年8月于广西贵港市人民医院治疗的118例老年肺癌患者为研究对象,并将其随机分为对照组和研究组两组。对照组实施开胸肺癌根治术,研究组实施胸腔镜微创手术,对比并分析两组的治疗疗效、并发症发生情况、手术指标及肺功能。结果表明,与对照组相比,研究组疗效更显著(P<0.05);研究组术中出血量更低(P<0.05);研究组引流时间、住院时间更短(P<0.05);治疗后,研究组FVC、FEV1、FEV1/FVC水平均比对照组高(P<0.05)。治疗前,两组血液流变学指标比较,无统计学差异(P>0.05);治疗后,研究组高切全血黏度、低切全血黏度及血浆黏度均比对照组低(P<0.05)。研究发现,针对老年肺癌患者应用胸腔镜微创手术,不仅可以降低并发症发生率,减少患者术中出血量,同时可以改善患者的肺功能,提高临床疗效,加快患者血液流变学各项指标水平恢复,进而达到缩短康复周期的效果,有利于缓解患者的经济压力,值得推广应用。

Lobectomy by video-assisted thoracoscopic surgery(VATS)for early stage of non-small cell lung cancer

Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC.

老年肺癌患者全身麻醉胸腔镜手术术后发生认知功能障碍的影响因素分析

目的分析老年肺癌患者全身麻醉胸腔镜手术术后发生认知功能障碍的影响因素。方法选取2021年1月至2023年12月在首都医科大学附属北京胸科医院进行全身麻醉胸腔镜手术治疗的90例老年肺癌患者为研究对象,根据术后5 d是否发生认知功能障碍将研究对象分为认知功能正常组(未发生认知功能障碍,69例)和认知功能障碍组(发生认知功能障碍,21例)。分析老年肺癌患者全身麻醉胸腔镜手术术后认知功能障碍的发生情况。采用单因素分析以及多因素logistic回归方法分析老年肺癌患者全身麻醉胸腔镜手术术后发生认知功能障碍的独立影响因素。结果本研究中,术后5 d,老年肺癌患者全身麻醉胸腔镜手术术后的认知功能障碍发生率为23.33%。认知功能障碍组患者年龄≥75岁的比例、术前美国麻醉医师协会(ASA)分级为Ⅲ~Ⅳ级的比例、麻醉维持时间≥3 h的比例、麻醉苏醒时间>30 min的比例、术后视觉模拟评分法(VAS)评分>3分的比例和术后睡眠质量较差的比例均高于认知功能正常组,术中麻醉深度为50~60的比例低于认知功能正常组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄≥75岁、术前ASA分级为Ⅲ~Ⅳ级、麻醉维持时间≥3 h、麻醉苏醒时间>30 min、术后VAS评分>3分和术后睡眠质量较差均为老年肺癌患者全身麻醉胸腔镜手术术后发生认知功能障碍的独立危险因素(P<0.05),术中麻醉深度为50~60是老年肺癌患者全身麻醉胸腔镜手术术后发生认知功能障碍的独立保护因素(P<0.05)。结论年龄越大、术前ASA分级越高、麻醉维持时间和苏醒时间越长、术后疼痛越剧烈、睡眠质量越差的老年肺癌患者全身麻醉胸腔镜手术术后发生认知功能障碍的风险越高,而术中麻醉深度较好的老年肺癌患者全身麻醉胸腔镜手术术后发生认知功能障碍的风险较低。

单操作孔电视胸腔镜肺癌根治术治疗非小细胞肺癌患者的疗效观察

目的观察单操作孔电视胸腔镜(VATS)肺癌根治术对非小细胞肺癌(NSCLC)血管内皮生长因子受体2(VEGFR2)、胸苷激酶1(TK1)水平的影响。方法我院收治的245例NSCLC患者,按手术方式分为对照组(三孔胸腔镜肺癌根治术,n=115)和观察组(单操作孔VATS肺癌根治术,n=130),比较两组围术期指标、视觉模拟(VAS)评分、肺功能、炎性因子、肿瘤标志物、VEGFR2、TK1水平及并发症。结果观察组术中出血量较对照组少(P<0.05);术后,观察组VAS评分、炎性因子、肿瘤标志物和VEGFR2、TK1水平低于对照组,肺功能高于对照组(P<0.05)。结论单操作孔VATS肺癌根治术治疗NSCLC出血量少、疼痛轻,可改善肺功能,降低炎性因子、肿瘤标志物和VEGFR2、TK1水平,且不增加术后并发症,值得临床推广。

右美托咪定复合地塞米松肋间神经阻滞用于老年肺癌患者胸腔镜根治术后镇痛的效果分析

目的 分析右美托咪定复合地塞米松肋间神经阻滞在老年肺癌患者胸腔镜根治术后镇痛中的效果。方法 选取2020年12月—2023年6月在无锡市第五人民医院行胸腔镜根治术的82例老年肺癌患者,采用随机数字表法分为对照组和研究组,每组41例。对照组术毕给予地塞米松复合罗哌卡因肋间神经阻滞,研究组术毕给予右美托咪定复合地塞米松、罗哌卡因肋间神经阻滞。比较两组肋间神经阻滞及术后静脉自控镇痛(PCIA)用药情况,对比两组围手术期疼痛、认知功能、应激反应、炎症反应及麻醉相关药物不良反应情况。结果 研究组肋间神经阻滞镇痛持续时间长于对照组,术后48 h舒芬太尼消耗总量少于对照组(P <0.05)。研究组与对照组术后4、12、24和48 h的视觉模拟评分(VAS)评分比较,结果:(1)不同时间点VAS评分比较,差异有统计学意义(F=9.156,P=0.000);(2)研究组与对照组VAS评分比较,差异有统计学意义(F=7.851,P=0.000);(3)两组VAS评分变化趋势比较,差异有统计学意义(F=7.061,P=0.000)。研究组与对照组术前及术后24和48 h的简易精神状态检查(MMSE)量表评分比较,结果:(1)不同时间点MMSE评分比较,差异无统计学意义(F=0.179,P=0.834);(2)研究组与对照组MMSE评分比较,差异无统计学意义(F=0.151,P=0.859);(3)两组MMSE评分变化趋势比较,差异无统计学意义(F=0.309,P=0.724)。研究组与对照组术前及术后24、48 h的肾上腺素(Adr)、皮质醇(Cor)比较,结果:(1)不同时间点Adr、Cor比较,差异均有统计学意义(F=7.967和8.043,均P=0.000);(2)研究组与对照组Adr、Cor比较,差异均有统计学意义(F=7.123和7.691,均P=0.000);(3)两组Adr、Cor变化趋势比较,差异均有统计学意义(F=8.003和7.961,均P=0.000)。研究组与对照组开始麻醉及术后24和48 h的肿瘤坏死因子α(TNF-α、)高迁移率族蛋白B1(HMGB1)比较,结果:(1)不同时间点TNF-α、HMGB1比较,差异均有统计学意义(F=8.236和8.417,均P=0.000);(2)研究组与对照组TNF-α、HMGB1比较,差异均有统计学意义(F=6.298和7.215,均P=0.000);(3)两组TNF-α、HMGB1变化趋势比较,差异均有统计学意义(F=7.035和7.152,均P=0.000)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 右美托咪定复合地塞米松肋间神经阻滞用于老年肺癌患者胸腔镜根治术后镇痛可延长肋间神经阻滞时间,减少术后舒芬太尼消耗量,并可减轻术后疼痛、应激反应及炎症反应,且安全性良好。

肺癌胸腔镜手术患者术后咳嗽的研究进展

咳嗽是肺癌行胸腔镜手术的患者术后常见的并发症,其发生率高,持续时间长,严重影响患者的生活质量。本研究对肺癌胸腔镜手术患者术后不同阶段咳嗽的发生率与严重程度、评估工具、影响因素、干预措施进行综述,以期提高临床医护人员对术后咳嗽的重视程度,为后续开展规范化管理提供参考。

加速康复外科理念在胸腔镜肺癌根治术患者围术期的护理效果观察

目的观察加速康复外科理念在胸腔镜肺癌根治术患者围术期的护理效果。方法选取我院2021年1月至2023年1月收治的180例胸腔镜肺癌根治术患者,随机分为两组。对照组行常规护理,实验组在对照组基础上采用加速康复外科理念护理,比较两组的护理效果。结果护理后,实验组SAS、SDS评分低于对照组(P<0.05)。实验组首次下床时间、首次进食时间、胸腔引流管留置时间、平均住院时间短于对照组(P<0.05)。实验组并发症发生率为2.22%,低于对照组的16.67%(P<0.05)。结论加速康复外科理念护理可缓解胸腔镜肺癌根治术患者围术期负性情绪,缩短术后恢复时间及住院时间,降低并发症发生率。

基于加速康复外科理念的营养干预对胸腔镜肺癌切除术患者的效果

目的探讨基于加速康复外科(ERAS)理念的营养干预对胸腔镜肺癌切除术患者的影响。方法选取本院2021年1月至2022年12月收治的92例肺癌切除术患者,按入院顺序随机分为两组,各46例,对照组给予常规营养干预,研究组予以ERAS理念营养干预,对比两组营养状况、术后恢复情况和并发症发生情况。结果两组干预后BMI、血清白蛋白、前白蛋白、转铁蛋白、三角肌皮褶厚度水平均有所降低,但研究组水平较对照组更高(P<0.05)。研究组首次下床时间、日下床活动时间、拔管时间、住院时间均短于对照组,术后1~3 d的胸腔引流量低于对照组(P<0.05)。研究组肺不张、肺部感染、心律失常、尿潴留等并发症发生率为4.35%,较对照组的19.57%低(P<0.05)。结论对胸腔镜肺癌切除术患者实施基于ERAS理念的营养干预能有效改善患者的营养状况,促进患者术后快速恢复,降低并发症的发生。

四逆散联合桃红四物汤加减治疗老年早期肺癌胸腔镜术后急性胸痛患者的临床疗效及对其生活质量的影响

目的探讨四逆散联合桃红四物汤加减治疗老年早期肺癌胸腔镜术后急性胸痛患者的临床疗效及对其生活质量的影响。方法选取2019年1月-2020年6月期间在保定市第二中心医院接受治疗的86例非小细胞肺癌患者,采用随机数字表法分为对照组和观察组,每组各43例。对照组患者胸腔镜术后给予尼美舒利胶囊口服治疗,观察组患者胸腔镜术后给予四逆散合桃红四物汤加减方治疗。治疗2周后,观察比较两组患者临床疗效、不良反应情况,治疗前后疼痛状况评分[数字分级评分法评分(Numeric rating scale,NRS)、疼痛视觉模拟评分法评分(Visual analogue scale,VAS)]、咳嗽评分[咳嗽积分和咳嗽视觉模拟评分法(Visual analogue scale,VAS)]、EORTC QLQ-C30(version 3)生活质量量表评分。结果治疗后观察组总有效率93.02%(40/43)明显高于对照组74.42%(32/43),差异有统计学意义(P<0.05)。治疗后两组患者疼痛状况NRS、VAS评分均较治疗前明显降低,差异有统计学意义(P<0.01);且观察组疼痛状况NRS、VAS评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者咳嗽状况咳嗽积分、咳嗽VAS评分均较治疗前明显降低,差异有统计学意义(P<0.01);且观察组咳嗽状况咳嗽积分、咳嗽VAS评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者角色功能、躯体功能、认知功能、情绪功能、社会功能及总体健康状况评分均较治疗前升高,差异有统计学意义(P<0.01),两组患者恶心呕吐、疼痛评分均较治疗前降低,差异有统计学意义(P<0.01);且观察组角色功能、躯体功能、认知功能、情绪功能、社会功能及总体健康状况评分均明显高于对照组,观察组恶心呕吐、疼痛评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者肾功能、肝功能、血常规、心电图、尿常规、便常规等安全性指标均未出现明显异常,也未发生与药物使用相关的严重不良反应。结论四逆散合桃红四物汤加减方能够有效缓解早期肺癌患者胸腔镜术后急性疼痛程度和咳嗽程度,缩短疼痛治疗时间,减少西医止痛药物使用剂量,改善患者生活质量,安全且有效。

非小细胞肺癌治疗中应用电视辅助胸腔镜手术的效果及对免疫功能的影响

目的探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)治疗中应用电视辅助胸腔镜手术的效果及对免疫功能的影响。方法选取2019年10月—2021年10月泉州市第一医院胸外科收治的以NSCLC为诊断的96例患者,以随机数字表法分为2组,各48例。研究组以电视辅助胸腔镜手术治疗,对照组以常规手术治疗。比较2组患者围手术期相关指标,检测2组患者术前、术后3 d时的炎症指标、免疫功能指标,统计患者术后并发症发生情况。结果研究组术中出血量少于对照组,且术后引流管留置时间、术后镇痛时间与住院时间短于对照组,差异有统计学意义(P<0.05)。2组术前的炎症指标、免疫功能指标比较,差异无统计学意义(P>0.05)。术后3 d,2组炎症指标较术前有所提升,其中研究组提升程度低于对照组,而血清免疫功能指标较术前有所下降,其中研究组下降程度低于对照组,差异有统计学意义(P<0.05)。研究组患者术后并发症总发生率为4.17%,低于对照组的18.75%,差异有统计学意义(P<0.05)。结论在NSCLC患者的治疗中以电视辅助胸腔镜手术治疗可减少术中出血量,缩短术后引流管留置时间、术后镇痛时间与住院时间,对于机体炎症指标及免疫功能指标影响较小,术后并发症发生率更低。

无肠道准备对胸腔镜肺癌根治术后患者康复及肠道功能的影响

目的观察无肠道准备对胸腔镜肺癌根治术后患者康复情况及肠道功能的影响。方法本文为随机对照试验,病例纳入南阳医学高等专科学校第一附属医院2021年1月至2023年3月收治的122例肺癌患者,采用随机数字表法对入组患者进行分组,分别列为常规组(61例)和试验组(61例)。常规组中男40例,女21例,年龄48~72(60.32±5.25)岁;试验组中男41例,女20例,年龄50~70(61.42±5.31)岁。所有患者均行胸腔镜下肺癌根治术治疗,常规组术前服用复方聚乙二醇电解质散进行肠道准备,试验组不采取术前肠道准备措施。比较两组患者术后恢复情况,术后胃肠功能、炎症指标变化情况,胃肠道不良反应发生情况及手术安全性。用χ^(2)检验、t检验。结果在不同治疗方案下,试验组的手术时间为(170.44±20.35)min、略长于常规组(167.35±20.46)min,差异无统计学意义(P>0.05);试验组的术后排气时间、排便时间、住院时间分别为(20.25±5.14)h、(23.36±5.42)h、(8.76±2.47)d,均短于常规组[(23.77±5.18)h、(26.62±5.41)h、(10.36±3.22)d],差异均有统计学意义(均P<0.05)。术前,两组患者的胃肠功能指标差异均无统计学意义(均P>0.05);在不同治疗方案下,试验组术后的胃泌素(GAS)、胃动素(MLT)分别为(70.22±10.37)ng/L、(78.45±10.27)ng/L,均低于常规组[(75.45±10.26)ng/L、(86.33±10.28)ng/L],差异均有统计学意义(均P<0.05)。治疗前,两组患者的炎症指标差异均无统计学意义(均P>0.05);在不同治疗方案下,试验组术后的C-反应蛋白(CRP)、白细胞介素-6(IL-6)水平分别为(15.45±4.49)mg/L、(12.33±3.47)ng/L,均低于常规组[(18.77±4.18)mg/L、(15.66±4.14)ng/L],差异均有统计学意义(均P<0.05)。在不同治疗方案下,试验组的胃肠道不良反应发生率为8.20%(5/61),低于常规组21.31%(13/61),差异有统计学意义(P<0.05);试验组的手术相关并发症发生率为9.84%(6/61),略高于常规组8.20%(5/61),差异无统计学意义(P>0.05)。结论术前无肠道准备能加快胸腔镜肺癌根治术患者术后康复进程,对避免术后胃肠功能紊乱、炎症反应发生并降低胃肠道不良反应发生风险均有积极意义,与传统术前肠道准备措施相比,无肠道准备未明显增加手术相关并发症发生风险,具有较高应用价值。