摘要
目的探讨老年自发性气胸患者行单孔胸腔镜肺大疱切除术术中行肋间神经阻滞、不做胸膜摩擦及使用细管引流从而减轻术后疼痛的安全性和有效性。方法 77例行单孔胸腔镜肺大疱切除术的老年自发性气胸患者,术中使用亚甲蓝+罗哌卡因行肋间神经阻滞,术中不做胸膜摩擦,术后使用细软管引流。观察患者的手术指标、并发症、疼痛情况及术后随访情况。结果手术指标:77例患者均顺利完成手术。手术时间42~90 min,平均手术时间68 min。术后住院时间3~15 d,平均术后住院时间6.5 d。并发症:无围手术期死亡,无术后出血,术后1例肺不张,2例拔除胸管后中量胸腔积液,2例肺部感染,2例术后持续漏气。疼痛情况:73例术后第1天、第3天视觉模拟评分法(VAS)评分均≤3分,未作止痛处理;2例术后第1天VAS评分5分,第3天VAS评分3分,使用止痛药1次;2例术后第1天VAS评分6分,第3天VAS评分4分,使用止痛药2次。术后随访:术后成功随访73例(94.8%),随访3~12个月,随访12个月的59例。2例出院后气胸复发,均入院行胸腔闭式引流术、胸腔内注入粘连剂后痊愈出院。结论老年自发性气胸患者行单孔胸腔镜肺大疱切除术,术中行肋间神经阻滞、不做胸膜摩擦及使用细管引流能有效减轻术后疼痛,安全、可行。
Objective To investigate the safety and efficacy of single-port thoracoscopic pulmonary bulla resection（included intraoperative intercostal nerve block, without pleural friction and postoperative drainage with soft tube for relieving postoperative pain） in the treatment of elderly patients with spontaneous pneumothorax. Methods A total of 77 elderly patients with spontaneous pneumothorax underwent singleport thoracoscopic pulmonary bulla resection without pleural friction, and treated with Methylene blue and Ropivacaine for intraoperative intercostal nerve block. Then soft tube drainage was placed after surgery. The operative indexes, complications, pain situation and postoperative follow-up were observed. Results Operative indexes： all patients completed the surgery successfully. The mean operative time was 68 min（the range from 42 min to 90 min）. The mean postoperative hospital stay was 6.5 d（the range from 3 d to 15 d）. Complications： no perioperative death and no postoperative bleeding. There were 1 case of atelectasis after surgery, 2 cases of moderate pleural effusion after removal of chest tube, 2 cases of pulmonary infection, and 2 cases of persistent air leakage after surgery. Pain situation： 73 cases received visual analogue scale（VAS） scores on the first day or third day after surgery, all of them were less than or equal to 3 scores, and no pain relief treatment was done. The VAS score of 2 patients was 5 scores on the first day after surgery, 3 scores on the third day after surgery, and the analgesics was used for one time. The VAS score of 2 patients was 6 scores on the first day after surgery, 4 scores on the third day after surgery, and the analgesics was used for two times. Postoperative follow-up： 73 cases（94.8%） were followed up for 3-12 months, and 59 cases were followed up for 12 months. After discharge, the pneumothorax recurred in 2 patients, all of them were discharged from hospital by closed thoracic drainage and injected with adhesions in the chest. Conclusion The single-port thoracoscopic pulmonary bulla resection which with intraoperative intercostal nerve block, without pleural friction and postoperative drainage with soft tube in the treatment of elderly patients with spontaneous pneumothorax can effectively reduce postoperative pain, and it is safe and feasible.
作者
钟标
李勇生
魏崴
黎佩建
ZHONG Biao;LI Yong-sheng;WEI Wei(Department of Cardiothoracic Surgery,Huizhou Cenrtal People＇s Hospital,Huizhou 516000,China)
出处
《中国实用医药》
2018年第23期19-21,共3页
China Practical Medicine
关键词
电视胸腔镜手术
自发性气胸
肋间神经阻滞
胸膜摩擦
胸腔引流
Video-assisted thoracoscopie surgery
Spontaneous pneumothorax
Intercostal nerve block
Pleural friction
Chest drainage
