本文關(guān)鍵詞：探討快速康復外科在肺大皰圍手術(shù)期的應用價值　出處：《新疆醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 快速康復外科 傳統(tǒng)手術(shù)外科 胸腔鏡肺大皰切除術(shù) 自發(fā)性氣胸

【摘要】：目的:本課題旨在探討快速康復外科(Fast Track Surgery,FTS)理念在肺大皰手術(shù)在圍手術(shù)期中應用的可行性和安全性,評估FTS理念在肺大皰手術(shù)圍手術(shù)期應用的優(yōu)勢。方法:回顧性分析2006年1月至2016年6月我院采用快速康復理念治療的90例肺大皰并發(fā)氣胸患者,其中采用快速康復外科治療的共48例,為FTS組;采用傳統(tǒng)手術(shù)外科治療的共42例,為CTS組。比較兩組術(shù)式比較兩組術(shù)后肺部并發(fā)癥(肺部感染、胸腔積液、肺漏氣時間7d)、術(shù)后疼痛、術(shù)后嘔吐、疼痛、留置胸管時間、術(shù)后住院時間等。結(jié)果:FTS組術(shù)后24h氧合指數(shù)(310.2±15.4)mmHg,CTS組術(shù)后24h氧合指數(shù)(328.6±12.8)mmHg(1mmHg=0.133kPa),兩組24h氧和指數(shù)比較差異無統(tǒng)計學意義(P0.05)。兩組術(shù)后24h、48h、72h VAS評分,(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)差異均有統(tǒng)計學意義(P0.05),FTS組疼痛相對較輕。FTS組總術(shù)后并發(fā)癥、術(shù)后住院天數(shù)、住院費用分別為:9(18.8%)、(4.2±1.2)d、(1.4±0.4)萬,均低于CTS組的18(42.9%)、(7.9±1.8)d、(1.6±0.4)萬,兩組總術(shù)后并發(fā)癥、術(shù)后住院天數(shù)、住院費用相比差異有統(tǒng)計學意義(P0.05)�？焖倏祻徒M術(shù)后胸腔引流管引流時間為(3.5±2.2)d,常規(guī)組為(7.3±4.3)d,胸腔引流管引流時間的差異有統(tǒng)計學意義(p0.05)。胃腸道功能恢復的標志為患者術(shù)后首次肛門排氣或排便時間,快速康復治療組胃腸道功能恢復時間為(4.36±1.08)h,明顯短于常規(guī)手術(shù)組的(8.63±1.47)h,差異有統(tǒng)計學意義(P0.05)。本文選取空腹血糖、C-反應蛋白作為應激指標,對比兩組術(shù)前二者差異無統(tǒng)計學意義(P0.05),而術(shù)后一天及術(shù)后五天二者差異有統(tǒng)計學意義(P0.05)。結(jié)論:快速康復外科理念(FTS)在胸腔鏡下肺大皰切除術(shù)中的應用是可行的、安全的,具有一定的優(yōu)勢。
[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 鹵15.4mmHg in the group of 20% FTS. In the CTS group, the oxygenation index was 328.6 鹵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 鹵1. 2 鹵1. 2 鹵1. 2 鹵1. 9). There was significant difference (P 0.05) between 1.7 鹵0.8 VSU and 3.6 鹵1.2VS0. 7 鹵1.0 VSU (2.5 鹵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 鹵1.2 days and 1.4 鹵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 鹵1.8 days and 1.6 鹵0.4000 respectively. The time of thoracic drainage was 3.5 鹵2.2 days in the rapid rehabilitation group and 7.3 鹵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 鹵1.08hs, which was significantly shorter than that in the conventional operation group (8.63 鹵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.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R655.3

【參考文獻】

相關(guān)期刊論文 前10條

1 方家佳;李元海;;超聲引導下胸椎旁神經(jīng)阻滯在開胸手術(shù)中的臨床應用研究進展[J];安徽醫(yī)藥;2017年01期

2 徐進;;快速康復護理進展及外科應用[J];齊魯護理雜志;2016年24期

3 鐘鳳玲;甘海鷹;陳贊倩;;快速康復外科護理在電視胸腔鏡手術(shù)患者圍手術(shù)期護理中的應用[J];護理實踐與研究;2016年18期

4 黃宇光;;麻醉在快速康復外科中扮演的角色[J];廣東醫(yī)學;2016年18期

5 賈風菊;李麗;孫奇;邵麗;;開腹手術(shù)患者術(shù)中保溫方法的探討[J];中華現(xiàn)代護理雜志;2016年10期

6 張敏;蘇義;劉玉秀;易學明;;試論加速康復外科與醫(yī)療質(zhì)量建設(shè)[J];醫(yī)學研究生學報;2016年03期

7 崔健;李鐘;何江;金曉飛;金星;;自發(fā)性氣胸經(jīng)乳暈單孔胸腔鏡外科治療分析[J];浙江臨床醫(yī)學;2016年02期

8 張翔宇;韓敬泉;劉成;曹守強;趙桂彬;張凱;董慶;崔健;;原發(fā)性自發(fā)性氣胸的日間手術(shù)[J];中國微創(chuàng)外科雜志;2016年02期

9 劉子嘉;黃宇光;;臨床麻醉在快速康復外科方面新進展[J];中國醫(yī)學科學院學報;2015年06期

10 聶靜;向陽;;對某三甲綜合醫(yī)院住院天數(shù)與住院費用的分析[J];新疆醫(yī)學;2015年09期

，

本文編號：1412104