单腔中心静脉导管辅助胸腔引流对单孔胸腔镜肺叶切除术患者预后的影响  

Effects of thoracic drainage with single-cavity central venous catheter on the prognosis of patients undergoing uniportal video-assisted thoracoscopic surgery for pulmonary lobectomy

作　　者：何君玲 王小文[1] 焦嘉[1] 陈丹[1] 陈焕文[1] 杜铭[1] 吴庆琛[1] HE Junling;WANG Xiaowen;JIAO Jia;CHEN Dan;CHEN Huanwen;DU Ming;WU Qingchen(Department of Cardiothoracic Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;ICU of Cardiothoracic Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院胸心外科,400016 [2]重庆医科大学附属第一医院胸心外科ICU,400016

出　　处：《重庆医学》2020年第14期2279-2283,共5页Chongqing medicine

基　　金：重庆市科学技术委员会项目(CSTC2015JCYJA10099)。

摘　　要：目的探讨单腔中心静脉导管(CVC)用于单孔胸腔镜手术(VATS)肺叶切除胸腔引流的安全性及其对患者短期预后的影响。方法采用回顾性病例对照研究,收集分析2018年10月至2019年6月在该院胸外科连续完成单孔VATS肺叶切除并符合研究标准的非小细胞肺癌患者174例,根据术后留置胸腔引流管的方式分为单纯胸引管组(对照组,n=84)和单腔CVC组(CVC组,n=90),比较两组患者术后疼痛评分、胸引管带管时间、术后重症监护室(ICU)时间、术后住院时间、并发症发生率、住院费用、患者满意度等预后情况。结果两组患者临床特征与手术资料差异无统计学意义(P>0.05)。CVC组患者术后72 h疼痛评分[(3.0±1.2)分vs.(4.3±2.1)分,P<0.01]、术后胸引管留置时间[(2.4±1.0)d vs.(4.8±1.5)d,P<0.01]、ICU时间[(24.6±15.9)h vs.(48.2±16.1)h,P=0.02]、术后住院时间[(3.4±1.2)d vs.(5.9±1.7)d,P=0.01]及住院费用[(53496.0±18175.7)元vs.(66728.2±19797.4)元,P<0.01]均较对照组降低。两组患者术后并发症发生率比较,差异无统计学意义(P<0.05)。结论CVC辅助胸腔闭式引流可缩短胸引管留置时间、ICU留住时间和住院时间,减少术后疼痛和住院费用,具有良好的安全性和有效性。Objective To explore the safety of thoracic drainage with single-cavity central venous catheter(CVC)for uniportal video-assisted thoracoscopic(VATS)pulmonary lobectomy and its impact on the short-term prognosis of patients.Methods A retrospective case-control study was conducted analysing the clinical data of 174 patients with non-small cell lung cancer who underwent uniportal VATS pulmonary lobectomy in the Department of Cardiothoracic Surgery of this hospital from October 2018 to June 2019 and met the research criteria.All patients were divided into the chest tubes group(the control group,n=90)and the single-cavity CVC group(the CVC group,n=84).The indicators of prognosis,including postoperative pain score,duration of chest tube drainage,length of ICU stay,length of hospital stay,incidence of complications,hospitalization costs and patients satisfaction,were compared between the two groups.Results There was no significant difference in clinical features and surgical data between the two groups(P>0.05).Compared with the control group,the pain score at 72 h after operation[(3.0±1.2)points vs.(4.3±2.1)points,P<0.01],duration of chest tube drainage after operation[(2.4±1.0)d vs.(4.8±1.5)d,P<0.01],length of ICU stay[(24.6±15.9)h vs.(48.2±16.1)h,P=0.02],length of hospital stay[(3.4±1.2)d vs.(5.9±1.7)d,P=0.01]and hospitalization costs[(53496.0±18175.7)yuan vs.(66728.2±19797.4)yuan,P<0.01]were decreased.No statistically significant difference was found in the incidence of postoperative complications between the two groups(P>0.05).Conclusion The clinical application of thoracic drainage with single-cavity CVC can shorten the duration of chest tube drainage,length of ICU and length of hospitalization stay,reduce postoperative pain and hospitalization costs,and has good safety and effectiveness.

关 键 词：中心静脉导管 引流术 胸腔镜 肺叶切除 快速康复 

分 类 号：R655.3[医药卫生—外科学]