快速康复外科在中量创伤性血胸治疗中的应用  

The role of fast track surgery in the treatment of moderate traumatic hemothorax

作　　者：苟亚军[1] 陈翔宇[1] 刘涵[1] 王伟[1] 田铸[1] 刘明华[1] 

机构地区：[1]第三军医大学西南医院急救部,重庆400038

出　　处：《临床急诊杂志》2016年第6期420-423,共4页Journal of Clinical Emergency

基　　金：国家卫生行业科研专项(No:201302016)

摘　　要：目的:探讨快速康复外科(FTS)在中量创伤性血胸治疗中应用的可行性和有效性。方法:通过随机分组的方式,将2013-10-2016-01第三军医大学西南医院接诊的68例创伤性中量血胸患者,分别纳入FTS组和单纯胸腔闭式引流组。比较两种治疗方式对创伤性血胸清除效率以及患者围术期呼吸频率、VAS评分、呼吸功能、胸腔引流管带管时间、术后并发症发生率、住院时间、住院费用影响的差异。结果:2组间术前胸腔积液估算量差异无统计学意义,FTS组术中实际引流量较单纯胸腔闭式引流组更接近于术前估计量(P<0.05),且拔管前胸腔残余积液量估计量明显少于单纯胸腔闭式引流组。FTS组术后留置胸腔闭式引流管时间明显短于单纯胸腔闭式引流组(P<0.05)。FTS组较单纯胸腔闭式引流组术后24h、72h呼吸频率明显改善(P<0.05)。FTS组术后首日VAS较单纯胸腔闭式引流组明显改善(P<0.05)。FTS组术后24h、72h氧合指数均显著高于单纯胸腔闭式引流组(P<0.05)。FTS组平均总住院时间显著短于单纯胸腔闭式引流组(P<0.05)。2组间并发症发生率差异无统计学意义。结论:在对伴有中量血胸的胸部创伤患者进行早期治疗时,引入FTS理念,建立一套以胸腔镜微创手术为核心的规范化治疗策略,可以对胸部创伤进行早期确定性治疗,并显著缩短患者的治疗时间,加快患者术后呼吸功能恢复,减轻患者痛苦。Objective：To investigate The role of fast track surgery in the treatment of moderate traumatic hemothorax.Method：By the means of prospective randomized trial,68 cases of moderate traumatic hemothorax,who were admitted to Southwest Hospital of Third Military Medical University from October 2013 to January 2016,were randomly divided into FTS group or closed thoracic drainage group.The clinical data such as hemothorax removal efficiency,peri-operative respiratory rate,VAS score,respiratory function,chest drainage tube duration time,postoperative complication rate,hospitalization time and costs were observed and compared between two groups.Result：There was no difference in the preoperative estimated volume of hemothorax between those two groups.The actual drainage volume of FTS group was closer to the estimated volume than the closed thoracic drainage group（P〈0.05）,and the residual volume of FTS,which was estimated before extubation,was significantly less than the closed thoracic drainage group（P〈0.05）.The chest drainage tube duration of FTS group was significantly less than the closed thoracic drainage group（P〈0.05）.On 24 hand 72hpost operation,the respiratory rate was significantly improved in FTS group compared with closed thoracic drainage group（P〈0.05）.The VAS score of FTS group on the first postoperative day also significantly improved than with closed thoracic drainage group（P〈0.05）.On 24 hand 72hpost operation,the oxygenation index was significantly improved in FTS group compared with simple closed thoracic drainage group（P〈0.05）.The average hospital stay time of FTS group was significantly shorter than that in closed thoracic drainage group（P〈0.05）.There was no difference in incidence of complications between the two groups.Conclusion：Establishing a set of standardized treatment strategies,based on the minimally invasive thoracoscopic surgery,may provide early certain surgical treatment for patients with moderate traumatic hemothorax,meanwhile,may help them t

关 键 词：快速康复外科 创伤性血胸 电视胸腔镜手术 应激源 

分 类 号：R641[医药卫生—外科学]