目的 探讨胸腔内注射凝血酶在难治性气胸中的治疗效果及对患者氧化应激、肺损伤因子及预后的影响.方法 选取2020年1月至2021年12月邯郸市第一医院收治的92例难治性气胸患者,男性54例,女性38例,年龄(59.89±5.38)岁,年龄范围为33～85岁.将患者按不同治疗方法分为对照组(n=42)与研究组(n=50),对照组患者行持续胸腔闭式引流,研究组患者行持续胸腔闭式引流联合胸腔内注射凝血酶.比较两组患者的治疗效果、治疗相关指标[漏口闭合时间、总带管时间、住院时间及视觉模拟评分量表(VAS)评分]、患者氧化应激反应情况[皮质醇、超氧化物歧化酶(SOD)、丙二醛]、肺损伤因子[肺表面活性物质相关蛋白D(SP-D)、人克拉拉细胞蛋白(CC16)]水平、患者并发症发生情况及复发率.结果 研究组患者治疗有效率高于对照组;漏口闭合时间、总带管时间、住院时间、术后72 h VAS评分均优于对照组,差异有统计学意义(P＜0.05).治疗3周后,研究组患者血清皮质醇、丙二醛水平低于对照组;SOD水平高于对照组;血清SP-D低于对照组;CC16水平高于对照组;治疗1年后复发率低于对照组,差异有统计学意义(P＜0.05).两组患者不良反应发生率比较,差异无统计学意义(P＞0.05).结论 持续胸腔闭式引流联合胸腔内注射凝血酶可提升难治性气胸的治疗效果,有助于减轻疼痛程度,降低氧化应激与肺损伤,预防患者复发.
Effect of intrathoracic injection of thrombin on oxidative stress and lung injury factors in patients with refractory pneumothorax
Objective To evaluate the efficacy of intrathoracic injection of thrombin and drainage tube suspension in refractory pneumothorax and its influence on oxidative stress,lung injury factors and prognosis.Methods A total of 92 patients with refractory pneumothorax admitted to the First Hospital of Handan City from January 2020 to December 2021 were selected.There were 54 males and 38 females,aged(59.89±5.38)years old,ranging from 33 to 85 years old.Patients were divided into control group(n=42)and study group(n=50)according to different treatment methods.Patients in control group received continuous closed thoracic drainage,while patients in study group received continuous closed thoracic drainage combined with intrathoracic injection of thrombin.The treatment effect,treatment-related indicators[leakage closure time,total intubation time,hospitalization time and visual analogue scale(VAS)score],patients'oxidative stress reaction[cortisol,superoxide dismutase(SOD),malondialdehyde],lung injury factors[pulmonary surfactant-related protein D(SP-D),human Clara cell protein(CC16)]levels and the clinical symptoms of the two groups were compared.Results The effective rate of treatment in the study group was higher than that in the control group.The time of leakage closure,total catheter time,hospitalization time and VAS score of 72 hours after operation were better than those of the control group,and the differences were statistically significant(P＜0.05).After 3 weeks of treatment,the levels of serum cortisol and malondialdehyde in the study group were lower than those in the control group.The SOD level was higher than that of the control group.Serum SP-D was lower than that of control group;The level of CC16 was higher than that of the control group.After one year of treatment,the recurrence rate was lower than that of the control group,the differences were statistically significant(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups,the difference was not statistically significant(P＞0.05).Conclusion Intrathoracic injected thrombin on the basis of continuous closed thoracic drainage can further improve the effect of refractory pneumothorax,help to reduce pain,reduce oxidative stress and lung injury,prevent recurrence.
Refractory pneumothoraxIntraluminal injection of thrombinOxidative stressLung injury factor
万方数据
维普
