胸腔镜辅助小切口结核性毁损肺叶切除术的效果及对术后肺部并发症的影响  

Effect of video-assisted thoracic surgery with small incisions for tuberculous lung destruction and its influence on postoperative pulmonary complications

作　　者：汤少鹏[1] Tang Shaopeng(Department of Thoracic Surgery,Henan Chest Hospital,Chest Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院,郑州大学附属胸科医院胸外科,郑州450000

出　　处：《中国实用医刊》2024年第8期9-13,共5页Chinese Journal of Practical Medicine

摘　　要：目的探讨胸腔镜辅助小切口结核性毁损肺叶切除术的效果及对术后肺部并发症(PPCs)的影响。方法前瞻性研究。抽取2020年5月至2023年8月于河南省胸科医院拟行结核性毁损肺叶切除术患者100例,依据随机数字表法将其分成对照组与观察组,每组50例。对照组患者接受常规性开胸手术,观察组患者接受胸腔镜辅助小切口结核性毁损肺叶切除术。比较两组围术期指标[术后气管导管拔管时间、麻醉后监测治疗室(PACU)入住时间、术后住院时间]、术后至出院前的PPCs发生率;比较两组麻醉诱导前10 min(T0)、切皮时(T1)、术毕即刻(T2)、术后24 h(T3)及术后72 h(T4)肺换气功能和弥散功能[肺泡-动脉血氧分压差(PA-aDO_(2))、肺泡氧合指数(OI)和呼吸指数(RI)];比较两组治疗前后肺功能[第1秒用力呼气容积占预测值的百分比(FEV1%pred)、用力肺活量占预计值的百分比(FVC%pred)和第1秒用力呼气容积/用力肺活量(FEV1/FVC)]。结果术后,观察组气管导管拔管时间、PACU停留时间均短于对照组(P均<0.05)。术后至出院前,观察组高碳酸血症发生率(2.0%,1/50)低于对照组(14.0%,7/50),观察组PPCs总发生率(10.0%,5/50)低于对照组(38.0%,19/50),差异有统计学意义(P<0.05)。T1~T4时,观察组PA-aDO_(2)和RI低于对照组,OI高于对照组(P<0.05)。术后2 d,两组FEV1%pred、FVC%pred和FEV1/FVC低于术前(P<0.05),且观察组FEV1%pred、FVC%pred和FEV1/FVC高于对照组(P<0.05)。结论胸腔镜辅助小切口结核性毁损肺叶切除术在降低患者PPCs发生率、改善患者术后肺功能方面优于常规性开胸手术。Objective To investigate the effect of video-assisted thoracosic surgery(VATS)with small incisions for tuberculous lung destruction and its influence on postoperative pulmonary complications(PPCs).Methods One hundred patients scheduled for lobectomy for tuberculous lung destruction in Henan Chest Hospital from May 2020 to August 2023 were selected for the prospective study.And they were divided into the control group and the observation group by random number table method,with 50 cases in each group.The control group underwent conventional open thoracotomy,while the observation group was treated by VATS with small incisions for tuberculous lung destruction.The perioperative indexes,including time to extubation,post-anesthesia care unit(PACU)stay and postoperative hospital stay,and the postoperative incidence of PPCs until discharge were compared between the two groups.Pulmonary ventilation and diffusion function evaluated by pulmonary-artery oxygen gradient(PA-aDO_(2)),oxygenation index(OI)and respiratory index(RI)of the two groups were compared before anesthesia induction(T0),at the time of skin incision(T1),immediately after the end of operation(T2),24 hours after operation(T3)and 72 hours after operation(T4).Pulmonary function evaluated by forced expiratory volume in 1 second percentage of predicted(FEV1%pred),forced vital capacity percentage of predicted(FVC%pred)and forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC).Results Compared with the control group,the observation group had significantly shorter time to extubation and PACU stay(all P<0.05).The rate of hypercapnia in the observation group(2.0%,1/50)was lower than that in the control group(14.0%,7/50),moreover,the overall incidence of PPCs in the observation group(10.0%,5/50)was lower than that in the control group(38.0%,19/50),and the differences were significant(P<0.05).Compared with the control group,PA-aDO_(2) and RI in the observation group were lower,while OI in the observation group was higher at time points from T1 to T4(P<0.05

关 键 词：胸腔镜手术 肺功能 术后肺部并发症 肺结核 

分 类 号：R655.3[医药卫生—外科学]