胸腔镜肺叶切除患者术后引流液性质动态变化研究  

Dynamics and clinical significance of thoracic drainage fluid properties after thoracoscopic lobectomy

作　　者：罗远志 赵雷 耿弘 籍强[1] 左坤 周锴 何庚戌 LUO Yuanzhi;ZHAO Lei;GENG Hong;JI Qiang;ZUO Kun;ZHOU Kai;HE Gengxu(Department of Thoracic and Cardiovascular Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院胸心血管外科,河北张家口075000

出　　处：《中国肿瘤外科杂志》2022年第4期376-380,共5页Chinese Journal of Surgical Oncology

基　　金：国家自然科学基金资助项目(82172099)。

摘　　要：目的通过分析胸腔镜肺叶切除术患者术后胸腔引流液性质的动态变化趋势探究早期安全拔除胸腔引流管时机。方法选取2021年1月1日至2021年12月31日在河北北方学院附属第一医院胸心血管外科行胸腔镜肺叶切除患者43例,收集并观察分析术后1周胸腔引流液量、胸水常规、胸水生化等指标变化趋势。结果术后1周胸腔引流液量呈逐渐下降趋势,前4天下降速度较快,后3天下降趋势较缓;胸水常规在术后第4天由中性粒细胞占优转变为淋巴细胞占优;胸水生化中蛋白浓度和腺苷脱氨酶浓度在术后第4天由下降趋势转为开始上升趋势。结论胸腔镜肺叶切除术患者胸膜腔在术后前3天处于急性炎性反应阶段,在术后第4天前后过渡到免疫反应阶段,胸腔引流液性质的转变较引流液量变化更具有生理意义,此时拔出胸腔引流管是安全可行的。Objective To determine the optimal timing to remove chest tube safely by analyzing the dynamic changes of thoracic drainage fluid properties after thoracoscopic lobectomy.Methods Forty-three patients who underwent thoracoscopic lobectomy in the First Affiliated Hospital of Hebei North University from January 1^(st) to December 30^(th) of 2021were selected.The dynamics of thoracic drainage fluid volume,thoracic drainage fluid routine,thoracic drainage fluid biochemistry and other characteristics were recorded after one week of operation.Results The amount of thoracic drainage fluid showed a gradual downward trend,with a rapid decline in the first four days and a slow decline in the last three days.Thoracic drainage fluid routine changed from mononuclear cell predominance to polymorphonuclear cell predominance on the fourth day after operation.The protein concentration and adenosine deaminase concentration in thoracic drainage fluid biochemistry began to rise gradually on the fourth day after operation.Conclusions Acute inflammatory reaction can be observed in pleural cavity after three days of thoracoscopic lobectomy,which transitioned to the stage of immune reaction around the fourth day after operation when chest tube can be removed safely.The change in the properties of the pleural drainage fluid is more physiologically significant than the change in the amount of drainage fluid.

关 键 词：胸腔镜肺叶切除术 引流液性质 炎性反应 免疫反应 拔管时机 

分 类 号：R734.2[医药卫生—肿瘤]