摘要
目的探讨快速康复外科(fast track surgery,FTS)理念下的无管化治疗方式在肺大疱切除手术中的应用疗效。方法回顾性分析2015年1月至2017年12月在我院胸外科收治的45例(其中男29例、女16例,平均年龄26.1岁)电视胸腔镜手术(VATS)下行单孔操作肺大疱切除的患者的临床资料,其中术前留置胃管和导尿管、术中使用气管插管辅助呼吸、术后留置引流管等有管化治疗方式患者25例,为有管化组;术前不留置胃管和导尿管、术中采用喉罩辅助呼吸、术后不留置胸腔引流管等无管化治疗方式患者20例,为无管化组。结果无管化组术后疼痛指数显著低于有管化组(2.60±1.14 vs. 5.16±1.24,P<0.001),且无管化治疗组使用镇痛泵时间短于有管化组[(1.40±0.50)d vs.(2.84±0.75)d,P <0.001],差异有统计学意义。两者术后肺部并发症发生率差异无统计意义(P>0.05),但无管化组术后咽喉水肿、疼痛并发症低于有管化组(P=0.00)差异有统计学意义。无管化组术前麻醉时间[(15.00±2.59)min vs.(18.56±2.10)min,P<0.001]、手术时间[(95.30±4.38)min vs.(105.50±4.59)min,P<0.001]、下床活动时间[(1.23±0.35)d vs.(1.86±0.48)d,P<0.001]、住院时间[(9.45±1.66)d vs.(12.80±1.87)d,P<0.001]、住院费用[(20 245.96±1 113.02)元vs.(22 147.06±1 735.01)元,P<0.001]均低于或短于有管化组。结论在肺大疱切除术中,无管化治疗可缩短手术时间,减轻患者疼痛,缩短住院时间,从而促进术后恢复,并节省费用,是一种可推广的治疗手段。
Objective To evaluate the efficacy of tubless therapy for pulmonary bulla resection under the concept of fast track surgery. Methods We retrospectively analyzed the clinical data of 45 patients(29 males and 16 females at an average age of 26.1 years) with pulmonary bullae in our hospital between January 2015 and December 2017. These patients were divided into two groups. Among them, 25 patients were treated with preoperative gastric tubes and catheters,tracheal intubation anesthesia and postoperative drainage tubes(a tube group). And 20 patients were treated with no preoperative gastric tube or catheter, sublaryngeal anesthesia and no postoperative drainage tube(a tubless group). Results There was a statistical difference in postoperative pain index(2.60±1.14 vs. 5.16±1.24, P<0.001) and larynx complication(P=0.00) between the two groups. Shorter period of epidural analgesic tubes(1.40±0.50 d vs.2.84±0.75 d, P<0.001), shorter operation and anesthesia time(15.00±2.59 min vs. 18.56±2.10 min, P<0.001;95.30±4.38 min vs. 105.50±4.59 min, P<0.001), shorter hospital stay(9.45±1.66 d vs. 12.80±1.87 d, P<0.001), and less expense(20 245.96±1 113.02 yuan vs. 22 147.06±1 735.01 yuan, P<0.001) in the tubless group were found compared with the tube group. But there was no statistical difference in incidence of complication of lung(P=0.43) between the two groups.Conclusion Tubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery with shorter hospital stay and less expense, and is an advantageous treatment.
作者
曹雄
韩彪
马敏杰
蔺瑞江
张瑜
CAO Xiong;HAN Biao;MA Minjie;LIN Ruijiang;ZHANG Yu(The First Hospital, Lanzhou University, Lanzhou, 730000, P.R.China;First Clinical Medical College, Lanzhou University, Lanzhou, 730000, P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2019年第5期436-439,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
甘肃省青年科技基金计划(1606RJZA283)
关键词
快速康复外科
无管化治疗
肺大疱切除
Fast track surgery
tubless therapy
pulmonary bulla resection
