VATS辅助治疗创伤血胸患者的效果及对患者疼痛应激、炎症因子和肺功能恢复的影响  

Effects of VATS on pain stress,inflammatory factors and recovery of lung function in patients with traumatic hemothorax

作　　者：徐民欢 张贤礼 郭晖 XU Min-huan;ZHANG Xian-li;GUO Hui(Guizhou Medical University,Guiyang Guizhou 550025,China;Department of Emergency,Guizhou Hospital,Beijing Jishuitan Hospital,Guiyang Guizhou 550000,China;Department of Emergency,Affiliated Hospital of Guizhou Medical University,Guiyang Guizhou 550004,China)

机构地区：[1]贵州医科大学,贵州贵阳550025 [2]北京积水潭医院贵州医院急诊科,贵州贵阳550000 [3]贵州医科大学附属医院急诊科,贵州贵阳550004

出　　处：《临床和实验医学杂志》2024年第23期2518-2522,共5页Journal of Clinical and Experimental Medicine

基　　金：贵州省卫健委课题(编号:gzwkj2020030165)。

摘　　要：目的观察电视胸腔镜手术(VATS)辅助治疗创伤血胸患者的效果及对患者疼痛应激、炎症因子和肺功能恢复的影响。方法回顾性选取2020年1月至2023年3月就诊于贵州医科大学附属医院因创伤血胸行VATS治疗的60例患者作为观察组,选取同期性别、损伤类型及受伤原因相匹配的因创伤血胸行开胸手术治疗的52例患者作为对照组。比较两组术中、术后指标,以及两组术前、术后24 h的疼痛应激因子[P物质、5-羟色胺、皮质醇、去甲肾上腺素(NE)]、炎症因子[肿瘤坏死因子-α(TNF-α)、单核细胞趋化蛋白-1(MCP-1)、C反应蛋白(CRP)]差异,检测两组术后1、3个月肺功能[肺总容量(TLC)、用力肺活量(FVC)、最大呼气中期流量(MMEF)、第1秒用力呼气量占用力肺活量百分率(FEV1%pred)]差异,并比较两组的并发症发生情况。结果观察组手术时间、术后引流时间、止痛药使用时间、术后住院时间分别为(112.02±34.15)min、(5.64±2.19)d、(4.63±1.05)d、(8.02±1.66)d,均短于对照组[(155.85±40.58)min、(7.28±2.88)d、(6.72±1.66)d、(10.98±2.15)d],术中失血量、术后引流量分别为(546.96±94.05)、(642.02±197.42)mL,均少于对照组[(825.56±124.11)、(985.22±235.65)mL],差异均有统计学意义(P<0.05)。术后24 h,两组P物质、5-羟色胺、皮质醇、NE水平均较术前升高,观察组的P物质、5-羟色胺、皮质醇、NE水平分别为(234.52±64.52)ng/mL、(876.53±102.56)ng/mL、(230.44±28.97)nmol/L、(84.12±9.25)ng/mL,均低于对照组[(296.98±71.54)ng/mL、(987.86±118.54)ng/mL、(274.58±32.14)nmol/L、(96.23±11.7)ng/mL],差异均有统计学意义(P<0.05)。术后24 h,两组MCP-1、TNF-α、CRP水平均较术前升高,观察组的MCP-1、TNF-α、CRP水平分别为(232.74±45.66)ng/mL、(64.77±9.85)pg/mL、(66.36±10.75)mg/L,均低于对照组[(295.65±52.45)ng/mL、(82.59±10.14)pg/mL、(87.96±12.54)mg/L],差异均有统计学意义(P<0.05)。观察组术后1个月的TLC、FVC、MMEObjective To observe the effects of video-assisted thoracoscopic surgery(VATS)on pain stress,inflammatory factors and lung function recovery in patients with traumatic hemothorax.Methods Sixty patients who admitted to the Affiliated Hospital of Guizhou Medical University from January 2020 to March 2023 and were treated with VATS for traumatic haemothorax were retrospectively selected as the observation group,and 52 patients who were treated with open-heart surgery for traumatic haemothorax in the same period matched by gender,type of injury and cause of injury were selected as the control group.The intraoperative and postoperative indexes of the two groups were compared,and the differences of pain stress factors[substance P,5-hydroxytryptamine,cortisol,norepinephrine(NE)],inflammatory factors[tumor necrosis factor-α(TNF-α),monocyte chemotactic protein-1(MCP-1),C-reactive protein(CRP)]before and 24 h after operation were compared between the two groups.The lung function[total lung capacity(TLC),forced vital capacity(FVC),maximal mid-expiratory flow(MMEF),the percentage of forced expiratory volume in first second to forced vital capacity(FEV1%pred)]of the two groups at 1 and 3 months after operation were detected.The complications of the two groups were compared.Results The operation time,postoperative drainage time,analgesic use time,and postoperative hospital stay in the observation group were(112.02±34.15)min,(5.64±2.19)d,(4.63±1.05)d,and(8.02±1.66)d,respectively,which were shorter than those in the control group[(155.85±40.58)min,(7.28±2.88)d,(6.72±1.66)d,(10.98±2.15)d],the intraoperative blood loss and postoperative drainage volume were(546.96±94.05)and(642.02±197.42)mL,respectively,which were less than those in the control group[(825.56±124.11)and(985.22±235.65)mL],and the differences were statistically significant(P<0.05).At 24 h after operation,the levels of substance P,5-hydroxytryptamine,cortisol and NE in the two groups were higher than those before operation,and the levels of substance P,5

关 键 词：血胸 电视胸腔镜手术 疼痛应激 炎症因子 肺功能 

分 类 号：R65[医药卫生—外科学]