【摘要】：目的：比較自發(fā)性氣胸胸腔鏡肺大皰切除術(shù)中胸膜摩擦(機(jī)械性胸膜固定術(shù))、滑石粉(化學(xué)性胸膜固定術(shù))以及胸膜摩擦+滑石粉三種胸膜固定術(shù)的優(yōu)劣。 方法：2009年1月-2011年2月,對(duì)收入我院行手術(shù)治療的180名自發(fā)性氣胸患者依術(shù)中胸膜固定術(shù)的不同分為三組：A(胸膜摩擦)n=61、B(滑石粉)n=61和C(胸膜摩擦+滑石粉)n=58。所有患者均行胸腔鏡肺大皰切除加相應(yīng)胸膜固定術(shù)。采用方差分析比較手術(shù)時(shí)間、術(shù)后帶管時(shí)間、術(shù)后住院時(shí)間、術(shù)后腸外止疼藥需求。組間兩兩比較采用Bonferroni檢驗(yàn)。采用x2檢驗(yàn)比較發(fā)熱38.0℃率、發(fā)熱38.5℃率及氣胸術(shù)后相關(guān)并發(fā)癥發(fā)生率,氣胸術(shù)后相關(guān)并發(fā)癥包括胸頂殘腔、持續(xù)漏氣5天、血胸(引流新鮮血液,量200m1/h,持續(xù)3小時(shí))、拔管后胸腔積液、肺不張、肺炎、膿胸、ARDS。組間兩兩比較采用3×2列聯(lián)表的分割(a=0.05/3)。以P0.05為差異有統(tǒng)計(jì)學(xué)意義。(SPSS17.0)。 結(jié)果：術(shù)后數(shù)據(jù)采集,觀察到有統(tǒng)計(jì)學(xué)意義的差別如下：手術(shù)時(shí)間(A51.64±6.17B42.79±8.14C55.09±8.40min P0.001);術(shù)后住院時(shí)間(A5.95±2.35B5.10±0.98C5.21±1.81d P=0.008);術(shù)后腸外鎮(zhèn)痛藥需求(A2.48±0.60B2.61±0.74C4.34±0.64次／人P0.001);發(fā)熱38.0℃(A38B41C55P0.001)；發(fā)熱38.5℃(A3B4C14P0.001)；胸頂殘腔(A9B2C2P=0.026)；胸腔積液(A7B1C2P=0.046)：總并發(fā)癥人數(shù)(A23B7C6P0.001)。 結(jié)論：滑石粉組較其他兩組顯示出更短的手術(shù)時(shí)間和術(shù)后住院時(shí)間。胸膜摩擦組較其他兩組顯示出更高的并發(fā)癥發(fā)生率,而胸膜摩擦+滑石粉組較其他兩組顯示出更高的腸外鎮(zhèn)痛藥需求及發(fā)熱、高熱發(fā)生率,而在復(fù)發(fā)率、持續(xù)漏氣5天、肺不張、肺炎、膿胸、血胸發(fā)生率上三組患者則沒有統(tǒng)計(jì)學(xué)差異。因此,我們認(rèn)為滑石粉為胸腔鏡肺大皰切除后胸膜固定術(shù)的優(yōu)先選擇。
[Abstract]:Objective: to compare the advantages and disadvantages of pleural friction (mechanical pleural fixation), talc powder (chemical pleural fixation) and pleural friction talcum in spontaneous pneumothorax thoracoscopic pneumonectomy. Methods: from January 2009 to February 2011, 180 patients with spontaneous pneumothorax received surgical treatment in our hospital were divided into three groups according to the intraoperative pleural fixation. All patients underwent thoracoscopic pneumonectomy and pleural fixation. Variance analysis was used to compare the time of operation, the time of postoperative tube, the time of postoperative hospitalization and the demand of postoperative parenteral analgesic. Bonferroni test was used to compare the two groups. The rate of fever 38.0 鈩，

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