胸腔镜肺减容术治疗72例终末肺气肿患者的临床效果研究  

Study on Clinical Therapeutic Effect of video-assisted Thoracoscopic Lung Volume Reduction Surgery in 72 Cases with Pulmonary Emphysema

作　　者：冶治[1] 高哲俊[1] 鄂德秀 郭亚楠[1] 

机构地区：[1]青海省人民医院胸外科,810007

出　　处：《青海医药杂志》2017年第10期4-8,共5页Qinghai Medical Journal

摘　　要：目的:探讨胸腔镜肺减容术治疗终末肺气肿的临床疗效。方法:本文选择我院2012年5月—2016年4月收治的72例终末肺气肿患者随机分为观察组(n=36)和对照组(n=36)。对照组采用传统开胸肺减容术治疗,观察组采用胸腔镜肺减容术治疗。观察比较两组术中出血量等手术基本情况指标、VAS评分、肺功能及血气分析情况、血清炎性因子水平。结果:与对照组比较,观察组患者术后漏气时间较短(3.42±0.77)d vs(4.05±0.95)d,术中出血量较少(98.74±29.56)mL vs(5.41±33.28)mL,胸腔引流量较少(549.13±42.26)mL vs(92.28±50.17)mL,术后引流时间及住院时间较短(4.78±1.53)d vs(8.25±2.06)d,(9.62±1.85)d vs(16.23±3.04)d(P<0.05)。术后第1天、3天、5天、7天VAS评分均明显低于对照组(P<0.05)。两组患者术后FEV1、FVC及PaO2均明显上升(P<0.001),RV及PaCO2明显下降(P<0.001),但两组患者术后组间比较无统计学差异(P>0.05)。TNF-α、IL-1及IL-6均明显升高(P<0.001),观察组升高幅度明显低于对照组,(239.62±24.85)ng/L vs(403.22±33.59)ng/L;(23.19±2.36)ng/L vs(38.53±3.85)ng/L;(135.21±13.82)ng/L vs(186.69±16.30)ng/L(P<0.001)。结论:胸腔镜LVRS治疗终末肺气肿可有效改善患者肺功能,减少术中出血量及胸腔引流量,缩短术后漏气时间、引流时间及住院时间,减少术后疼痛及炎症反应,值得临床推广应用。Objective：This study aims to investigate the clinical effect of VATS in the treatment of pulmonary emphysema.Methods：72 patients admitted to our hospital from May 2012 to April 2016 were randomly divided into observation group（n=36）and control group（n=36）.The control group was treated with traditional open surgery,and the observation group was treated by VATS.Both of the two groups areobserved and compared with the basic operation index including the amount of blood loss,VAS score,level changes of CRP and PCT,quality of life improvement and complication.Results：Compared with the control group,the time of air leakage after operation in the observation group was shorter（3.42±0.77）d vs（4.05±0.95）d with lessthe amount of haemorrhage（98.74±29.56）mL vs（205.41±33.28）mL,the amount of drainage（549.13±42.26）mL vs（792.28±50.17）mL and the hospitalization time（4.78±1.53）d vs（8.25±2.06）d,（9.62±1.85）d vs（16.23±3.04）d,（P〈0.05）.After operation,the VAS score at 1,3,5,7 days in the operation group wassignificantly lower than thosein the control group（P〈0.05）.FEV1、FVC and PaO2 of both groups has clearly risen（P〈0.001）,while RV and PaCO2 has dropped obviously（P〈0.001）,but there is no significant difference on statistics（P〉0.05）.TNF-a、IL-1 and IL-6 has risen（P〈0.001）,which of the observation group is evidently lower than the control group（239.62±24.85）ng/L vs（403.22±33.59）ng/L;（23.19±2.36）ng/L vs（38.53±3.85）ng/L;1（35.21±13.82）ng/L vs（186.69±16.30）ng/L,（P〈0.001）.Conclusions：VATS in the treatment of pulmonary emphysema can improve the function of patients＇ lung,reduce the amount of haemorrhage and drainage,shorten the time of air leak,hospitalization and drainage,and release the pain after operation and inflammation,which is worth promoting.

关 键 词：终末肺气肿 胸腔镜手术 肺减容术 肺功能 血气分析 

分 类 号：R563.1[医药卫生—呼吸系统] R561[医药卫生—内科学]