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目的:探讨快速康复外科(FTS)在中量创伤性血胸治疗中应用的可行性和有效性。方法:通过随机分组的方式,将2013-10-2016-01第三军医大学西南医院接诊的68例创伤性中量血胸患者,分别纳入FTS组和单纯胸腔闭式引流组。比较两种治疗方式对创伤性血胸清除效率以及患者围术期呼吸频率、VAS评分、呼吸功能、胸腔引流管带管时间、术后并发症发生率、住院时间、住院费用影响的差异。结果:2组间术前胸腔积液估算量差异无统计学意义,FTS组术中实际引流量较单纯胸腔闭式引流组更接近于术前估计量(P<0.05),且拔管前胸腔残余积液量估计量明显少于单纯胸腔闭式引流组。FTS组术后留置胸腔闭式引流管时间明显短于单纯胸腔闭式引流组(P<0.05)。FTS组较单纯胸腔闭式引流组术后24h、72h呼吸频率明显改善(P<0.05)。FTS组术后首日VAS较单纯胸腔闭式引流组明显改善(P<0.05)。FTS组术后24h、72h氧合指数均显著高于单纯胸腔闭式引流组(P<0.05)。FTS组平均总住院时间显著短于单纯胸腔闭式引流组(P<0.05)。2组间并发症发生率差异无统计学意义。结论:在对伴有中量血胸的胸部创伤患者进行早期治疗时,引入FTS理念,建立一套以胸腔镜微创手术为核心的规范化治疗策略,可以对胸部创伤进行早期确定性治疗,并显著缩短患者的治疗时间,加快患者术后呼吸功能恢复,减轻患者痛苦。
Objective: To investigate the feasibility and effectiveness of rapid rehabilitation surgery (FTS) in the treatment of traumatic hemothorax. Methods: Sixty-eight patients with traumatic middle-volume hemothorax admitted to Southwest Hospital of the Third Military Medical University from October 2013 to October 2016 were enrolled in the FTS group and the thoracic closed drainage group respectively by randomized grouping. The effects of the two treatments on traumatic hemopneumothorax, as well as the respiratory rate, VAS score, respiratory function, time of chest tube drainage, incidence of postoperative complications, hospitalization time and hospitalization expense were compared. Results: There was no significant difference between the two groups in estimating the amount of preoperative pleural effusion. The actual drainage volume in the FTS group was closer to the preoperative estimate (P <0.05) than that in the thoracic closed drainage group, Estimated residual fluid volume was significantly less than simple thoracic drainage group. The time of postoperative closed thoracic drainage in the FTS group was significantly shorter than that in the closed thoracic drainage group (P <0.05). Respiratory frequency of FTS group was significantly improved at 24 and 72 hours after operation (P <0.05). VAS on the first postoperative day in the FTS group was significantly improved compared with the simple thoracic closed drainage group (P <0.05). The oxygenation index of FTS group was significantly higher than that of simple thoracic drainage group (P <0.05) at 24h and 72h after operation. The mean total length of stay in the FTS group was significantly shorter than that in the closed thoracic drainage group (P <0.05). There was no significant difference in the incidence of complications between the two groups. Conclusion: In the early treatment of patients with thoracic trauma accompanied by moderate hemothorax, the concept of FTS was introduced to establish a standardized treatment strategy with thoracoscope minimally invasive surgery as the core to early definite treatment of chest trauma and Significantly shorten the treatment time of patients, accelerate the recovery of postoperative respiratory function and relieve the suffering of patients.