双细管引流在原发性自发性气胸单孔胸腔镜术后快速康复中的应用  

Application and safety analysis of double-tube drainage in rapid rehabilitation of patients with primary spontaneous pneumothorax treated by single-hole thoracoscopy

作　　者：郭娟 李益梅 刘莉[3] Guo Juan;Li Yimei;Liu Li(Operating Room,Xuzhou Central Hospital of Jiangsu Province,Jiangsu Xuzhou 221000,China;Department of Intensive Medicine,Zaozhuang Traditional Chinese Medicine Hospital,Shandong Zaozhuang 277100,China;Department of Cardiac Surgery,Xuzhou Central Hospital of Jiangsu Province,Jiangsu Xuzhou 221000,China)

机构地区：[1]江苏省徐州市中心医院手术室,江苏徐州221000 [2]山东省枣庄市中医医院重症医学科,山东枣庄277100 [3]江苏省徐州市中心医院心脏外科,江苏徐州221000

出　　处：《中国医刊》2020年第5期522-525,共4页Chinese Journal of Medicine

基　　金：江苏省青年医学科学人才培养计划(ONRC2016382)。

摘　　要：目的探讨双细管引流在原发性自发性气胸患者单孔胸腔镜治疗术后快速康复中的应用效果及其安全性。方法选取2017年8月至2019年3月在江苏省徐州市中心医院接受单孔胸腔镜治疗的原发性自发性气胸患者68例,随机分为观察组和对照组,每组34例。观察组在实施单孔胸腔镜肺大疱切除术后留置双细管引流,对照组在实施单孔胸腔镜肺大疱切除术后留置单粗管引流。观察并记录两组的引流管带管时间、住院时间,术前及术后1、3、7d的血清炎症及应激反应指标(包括去甲肾上腺素、皮质醇、血管紧张素Ⅱ、肿瘤坏死因子-α、白细胞介素-1、C反应蛋白)水平,术后1、2、4、7d静息状态和运动状态下的疼痛视觉模拟量表(visual analogue scale,VAS)评分,以及术后并发症发生情况。结果观察组术后引流管带管时间和住院时间均明显短于对照组,差异有显著性(P<0.05)。两组术前血清炎症及应激反应指标比较差异无显著性(P>0.05),术后1、3、7d观察组血清炎症及应激反应指标明显低于对照组(P<0.05)。两组术后1、2、4、7d静息和运动状态下的VAS评分逐渐降低,且观察组明显低于对照组,差异有显著性(P<0.05)。观察组术后并发症发生率为8.82%,明显低于对照组的67.65%,差异有显著性(χ2=8.449,P<0.05)。结论双细管引流可减轻原发性自发性气胸患者单孔胸腔镜治疗术后的疼痛及炎症和应激反应,降低并发症发生率,值得临床应用。Objective To explore the effect and safety of double tube drainage in the rapid rehabilitation of patients with spontaneous pneumothorax after single hole thoracoscopy.Method From August 2017 to March 2019,68 patients with primary spontaneous pneumothorax were randomly divided into the observation group and the control group,with 34 patients in each group,who were treated by single hole thoracoscope in Xuzhou Central Hospital of Jiangsu province.In the observation group,double thin tube drainage was reserved after the bullous resection of single hole thoracoscopy,while in the control group,single thick tube drainage was reserved after the bullous resection of single hole thoracoscopy.The time of drainage tube and hospitalization,the indexes of serum inflammation and stress reaction(including norepinephrine,cortisol,angiotensionⅡ,tumor necrosis factor-α,interleukin-1,C-reactive protein)before and 1,3,7 days after operation,the visual analogue scale of pain in resting state and exercise state 1,2,4,7 days after operation were observed and recorded Scale,VAS)score and postoperative complications.Result The time of drainage tube in the observation group was shorter than that in the control group(P<0.05).There was no significant difference between the two groups(P>0.05).The level of serum inflammation and stress reaction in the first,third and seventh day after operation was significantly lower than that before operation,and that in the observation group was significantly lower than that in the control group(P<0.05).The vas of the two groups decreased gradually after 1,2,4 and 7 days of rest and exercise,and the difference was significant(P<0.05).The incidence of postoperative complications in the observation group was 8.82%,which was significantly lower than 67.65%in the control group(χ2=8.449,P<0.05).Conclusion Double tube drainage can reduce the pain,inflammation and stress response of patients with spontaneous pneumothorax after single hole thoracoscopy,and reduce the incidence of complications.It is worthy of

关 键 词：原发性自发性气胸 单孔胸腔镜 双细管引流 快速康复 

分 类 号：R655.2[医药卫生—外科学]