中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

快速康复外科下无管化治疗方式在肺大疱切除术中的应用

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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,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。 结果 疼痛指数术后无管化组显著低于有管化组(2.60±1.14vs.5.16±1.24,P<0.001),且无管化治疗组使用镇痛泵时间低于有管化组[(1.40±0.50)dvs.(2.84±0.75)d,P <0.001]。两者术后肺部并发症发生率学差异无统计意义( 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=0.004)。术前麻醉时间[(15.00±2.59)minvs.(18.56±2.10)min,P<0.001]、手术时间[(95.3±4.38)minvs. 105.5±4.59)min,P<0.001]、下床活动时间[(1.23±0.35)dvs.(1.86±0.48)d,P<0.001]、住院时间[(9.45±1.66)dvs.(12.8±1.87)d,P<0.001]、住院费用[(20 245.96±111 3.02)vs.(22 147.06±1 735.01),P<0.001]无管化治疗组均低于有管化治疗组。 结论 在肺大疱切除术中无管化治疗方式可缩短手术时间,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,是一种有利的可推广的治疗手段。

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 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 preoperative gastric tubes and catheters, tracheal intubation anesthesia and postoperative drainage tubes, Sand 20 patients were treated nor preoperative gastric tubes or catheters, sublaryngeal anesthesia and no postoperative drainage tubes. Results There wassignificant statistical differences in postoperative pain index[(2.60±1.14)vs(5.16±1.24), P<0.001] and larynx complications(P=0.004) between two groups, shorter period of epidural analgesictubes[(1.40±0.50) dvs(2.84±0.75) d, P<0.001], shorter operation and anesthesia time[(15.00±2.59) minvs(18.56±2.10) min, P<0.001, (95.3±4.38) minvs(105.5±4.59) min, P<0.001], shorter hospital stays [(9.45±1.66) dvs(12.8±1.87) d, P<0.001] and less expenses[(20 245.96±1 113.02)vs(22 147.06±1 735.01), P<0.001] in the tubless group compared with the tubes group. but there was no significant statistical differences in incidence of complications of lung (P=0.43). Conclusion Tubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery, shorter hospital stays and less espenses, is an advantageous treatment.

关键词: 快速康复外科; 无管化治疗; 肺大疱切除

Key words: Fast track surgery; tubless therapy; pulmonary bulla resection

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