CAJ | 학술논문

目的探讨严重气胸快捷简单有效且适宜院前院内急救的治疗方法.方法 67例严重气胸患者随机分为观察组(34例)和对照组(33例).观察组采用腹腔镜穿刺鞘卡快速行胸腔闭式引流术,对照组采用传统大口径引流管及肋间常规切开方法行胸腔闭式引流术.分别观察2组手术时间、留管时间、住院时间、有效率以及术后疼痛、出血、皮下气肿、术后感染等并发症发生情况.结果观察组与对照组总有效率[94.1%(32/34),90.9%(30/33),x2=1.876,P＞0.05]、留管时间[(4.56±1.65)d与(6.26±3.45)d,t=1.335,P＞0.05]、住院时间[(6.0±2.6)d与(6.7±2.2)d,t=0.779,P＞0.05]比较差异无统计学意义;但观察组在操作时间[(5.00±1.28)min与(15.00±4.03)min,t=3.031,P＜0.05],切口范围[(0.95±0.11)cm与(2.41±0.52)cm,t= 2.585,P＜0.05]方面少于对照组,差异有统计学意义;术后疼痛发生率[14.7%(5/34)与87.9%(29/33),t=2.983,P＜0.05]、出血发生率[0 与36%(12/33),x2=5.880,P＜0.05]、切口感染发生率[0与33%(11/33),t=3.687,P＜0.05]较对照组更少,差异有统计学意义.结论应用腹腔镜穿刺鞘卡快速胸腔闭式引流术治疗气胸具有手术操作简单,易掌握,疗效可靠,并发症少等优点,适宜在院前院内急救中应用.
목적 탐토엄중기흉쾌첩간단유효차괄의원전원내급구적치료방법.방법 67례엄중기흉환자수궤분위관찰조(34례)화대조조(33례).관찰조채용복강경천자초잡쾌속행흉강폐식인류술,대조조채용전통대구경인류관급륵간상규절개방법행흉강폐식인류술.분별관찰2조수술시간、류관시간、주원시간、유효솔이급술후동통、출혈、피하기종、술후감염등병발증발생정황.결과 관찰조여대조조총유효솔[94.1%(32/34),90.9%(30/33),x2=1.876,P＞0.05]、류관시간[(4.56±1.65)d여(6.26±3.45)d,t=1.335,P＞0.05]、주원시간[(6.0±2.6)d여(6.7±2.2)d,t=0.779,P＞0.05]비교차이무통계학의의;단관찰조재조작시간[(5.00±1.28)min여(15.00±4.03)min,t=3.031,P＜0.05],절구범위[(0.95±0.11)cm여(2.41±0.52)cm,t= 2.585,P＜0.05]방면소우대조조,차이유통계학의의;술후동통발생솔[14.7%(5/34)여87.9%(29/33),t=2.983,P＜0.05]、출혈발생솔[0 여36%(12/33),x2=5.880,P＜0.05]、절구감염발생솔[0여33%(11/33),t=3.687,P＜0.05]교대조조경소,차이유통계학의의.결론 응용복강경천자초잡쾌속흉강폐식인류술치료기흉구유수술조작간단,역장악,료효가고,병발증소등우점,괄의재원전원내급구중응용.
Objective To explore a rapid,simple and effective therapy for serious pneumothorax which could be used in pre-hospital and in-hospital first-aid.Methods Sixty-seven patients were randomly divided into the observation group and control group .Patients in the observation group were treated using laparoscopic trocar for rapidly closed thoracic drainage,and patients in the control group were treated by using the traditional large caliber drainage tube and the intercostal incision method of conventional closed thoracic drainage.The operation time,remaining time of drainage,length of stay,effective rate,and complications,including of postoperative pain,hemorrhage,subcutaneous emphysema and infection were observed in both groups. Results The total effective rate was 94.1%(32/34) in the observation group,which was significantly higher than that in the control group(90.9%,30/33)(x2=1.876,P＞0.05).No significant difference was found on the remaining time of drainage and length of stay between the two groups(remaining time of drainage:[4.56±1.65]d vs.[6.26±3.45]d;length of stay:(6.0±2.6)d vs.(6.7±2.2)d ,t=1.335 and 0.779,respectively,Ps＞0.05).The operation time of using laparoscopic trocar was significantly lower than that of the control group((5.00±1.28)min vs.(15.00±4.03)min,t=3.031,P＜0.05).The incision length was(0.95±0.11)cm in the observational group,which was significantly lower than that in the control group((2.41±0.52)cm ,t=2.585,P＜0.05).Postoperative pain occurred in 14.7%(5/34) of patients in the observational group,which was significantly lower than that in the control group(87.9%(29/33))(t=2.983,P＜0.05).In the observational group no hemorrhage and infection occurred,whereas in the control group the hemorrhage and infection rate was 36%(12/33) and 33%(11/33),respectively(x2=5.880 and 3.687,respectively,Ps＜0.05). Conclusion The use of laparoscopic trocar for rapidly closed thoracic drainage in the treatment of serious pneu-mothorax is simple,easy,convenient,effective and reliable,with few complications.This therapy is suitable for using in pre-hospital and in-hospital first-aid.