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)μg/mL、(66.36±10.75)mg/L,均低于对照组[(295.65±52.45)ng/mL、(82.59±10.14)μg/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、MMEF、FEV1％pred均高于对照组,差异均有统计学意义(P＜0.05);观察组术后3个月的TLC、FVC、MMEF、FEV1％pred与对照组比较,差异均无统计学意义(P＞0.05).观察组总并发症发生率为5.00％,低于对照组(21.15％),差异有统计学意义(P＜0.05).结论 VATS辅助治疗创伤血胸具有手术创伤小、术后肺功能恢复快、并发症少的优点,可减轻机体应激反应,减少炎症因子释放.
Abstract
Objective 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 fac-tor-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 opera-tion 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,re-spectively,which were less than those in the control group[(825.56±124.11)and(985.22±235.65)mL],and the differences were statisti-cally 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-hydroxytryptamine,cortisol and NE in the observation group were(234.52±64.52)ng/mL,(876.53±102.56)ng/mL,(230.44±28.97)nmol/L and(84.12±9.25)ng/mL,respectively,which were lower than those in the control group[(296.98±71.54)ng/mL,(987.86±118.54)ng/mL,(274.58±32.14)nmol/L,(96.23±11.7)ng/mL],and the differences were statistically significant(P＜0.05).At 24 h after operation,the levels of MCP-1,TNF-α and CRP in the two groups were higher than those before operation,and the levels of MCP-1,TNF-α and CRP in the observation group were(232.74±45.66)ng/mL,(64.77±9.85)μg/mL and(66.36±10.75)mg/L,respectively,which were lower than those in the control group[(295.65±52.45)ng/mL,(82.59±10.14)μg/mL,(87.96±12.54)mg/L],the differences were statistically significant(P＜0.05).The TLC,FVC,MMEF and FEV1％pred of the observation group were higher than those of the control group at 1 month after operation,and the differences were statisti-cally significant(P＜0.05).There were no statistically significant differences in TLC,FVC,MMEF and FEV1％pred between the observation group and the control group at 3 months after operation(P＞0.05).The complication rate of the observation group was 5.00％,which was lower than that of the control group(21.15％),the difference was statistically significant(P＜0.05).Conclusion VATS-assisted treatment of traumatic haemothorax has the advantages of less surgical trauma,quicker recovery of postoperative lung function and fewer complications,which can reduce the stress response of the body and decrease the release of inflammatory factors.
维普
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