探讨快速康复外科在肺大疱围手术期的应用价值

发布时间：2018-01-12 01:26

本文关键词：探讨快速康复外科在肺大疱围手术期的应用价值　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本课题旨在探讨快速康复外科(Fast Track Surgery,FTS)理念在肺大疱手术在围手术期中应用的可行性和安全性,评估FTS理念在肺大疱手术围手术期应用的优势。方法:回顾性分析2006年1月至2016年6月我院采用快速康复理念治疗的90例肺大疱并发气胸患者,其中采用快速康复外科治疗的共48例,为FTS组;采用传统手术外科治疗的共42例,为CTS组。比较两组术式比较两组术后肺部并发症(肺部感染、胸腔积液、肺漏气时间7d)、术后疼痛、术后呕吐、疼痛、留置胸管时间、术后住院时间等。结果:FTS组术后24h氧合指数(310.2±15.4)mmHg,CTS组术后24h氧合指数(328.6±12.8)mmHg(1mmHg=0.133kPa),两组24h氧和指数比较差异无统计学意义(P0.05)。两组术后24h、48h、72h VAS评分,(2.3±1.2)VS(5.2±1.9),(1.7±0.8)VS(3.6±1.2),(0.7±1.0)VS(2.5±1.33)差异均有统计学意义(P0.05),FTS组疼痛相对较轻。FTS组总术后并发症、术后住院天数、住院费用分别为:9(18.8%)、(4.2±1.2)d、(1.4±0.4)万,均低于CTS组的18(42.9%)、(7.9±1.8)d、(1.6±0.4)万,两组总术后并发症、术后住院天数、住院费用相比差异有统计学意义(P0.05)。快速康复组术后胸腔引流管引流时间为(3.5±2.2)d,常规组为(7.3±4.3)d,胸腔引流管引流时间的差异有统计学意义(p0.05)。胃肠道功能恢复的标志为患者术后首次肛门排气或排便时间,快速康复治疗组胃肠道功能恢复时间为(4.36±1.08)h,明显短于常规手术组的(8.63±1.47)h,差异有统计学意义(P0.05)。本文选取空腹血糖、C-反应蛋白作为应激指标,对比两组术前二者差异无统计学意义(P0.05),而术后一天及术后五天二者差异有统计学意义(P0.05)。结论:快速康复外科理念(FTS)在胸腔镜下肺大疱切除术中的应用是可行的、安全的,具有一定的优势。
[Abstract]:Objective: to investigate the feasibility and safety of Fast Track Surgeryn (FTS) in the perioperative period of pulmonary bullous surgery. To evaluate the advantages of FTS in perioperative lung bullae surgery. Methods:. From January 2006 to June 2016, 90 cases of pulmonary bullae complicated with pneumothorax were analyzed retrospectively. Among them, 48 cases were treated by rapid rehabilitation surgery. They were FTS group. 42 cases were treated by traditional surgical treatment for CTS group. Compared the two groups of postoperative pulmonary complications (pulmonary infection, pleural effusion, lung leakage time 7 days), postoperative pain, postoperative vomiting. Results the oxygenation index of 24 hours after operation was 310.2 卤15.4mmHg in the group of 20% FTS. In the CTS group, the oxygenation index was 328.6 卤12.8 mm Hg1 mm Hgn 0.133 KPA 24 hours after operation. There was no significant difference in oxygen and index between the two groups in 24 hours after operation (P 0.05). The VAS score of 24 hours and 48 hours after operation was 2. 3 卤1. 2 卤1. 2 卤1. 2 卤1. 9). There was significant difference (P 0.05) between 1.7 卤0.8 VSU and 3.6 卤1.2VS0. 7 卤1.0 VSU (2.5 卤1.33). The pain in FTS group was relatively mild. The total postoperative complications, postoperative hospitalization days and hospitalization expenses in FTS group were 4.2 卤1.2 days and 1.4 卤0.4000, respectively. All of them were lower than that of CTS group (P < 0.01). The total postoperative complications and postoperative hospital stay in the two groups were 7.9 卤1.8 days and 1.6 卤0.4000 respectively. The time of thoracic drainage was 3.5 卤2.2 days in the rapid rehabilitation group and 7.3 卤4.3 days in the routine group. The difference of drainage time of thoracic drainage tube was statistically significant (p0.05). The sign of gastrointestinal function recovery was the first time of anal exhaust or defecation after operation. The recovery time of gastrointestinal function in the rapid rehabilitation group was 4.36 卤1.08hs, which was significantly shorter than that in the conventional operation group (8.63 卤1.47h). The difference was statistically significant (P 0.05). In this study, fasting blood glucose C-reactive protein was selected as stress index, and there was no significant difference between the two groups before operation (P 0.05). The difference between the first day and the fifth day after operation was statistically significant (P 0.05). Conclusion: the application of FTS in thoracoscopic pneumonectomy is feasible and safe. Have certain advantage.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.3

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