本文選題：甲狀腺外科 + 引流術(shù)��； 參考：《昆明醫(yī)科大學(xué)》2015年碩士論文

【摘要】：[目的]選擇擬行初次甲狀腺開(kāi)放手術(shù)的病例為研究對(duì)象,通過(guò)對(duì)術(shù)后引流量及其紅細(xì)胞、白細(xì)胞和引流管末端細(xì)菌培養(yǎng)等相關(guān)指標(biāo)的測(cè)定,構(gòu)建初次甲狀腺術(shù)后引流液量的變化趨勢(shì)圖及白細(xì)胞等感染因子的變化規(guī)律圖,并進(jìn)一步通過(guò)不同拔管時(shí)間對(duì)切口愈合的影響,臨床驗(yàn)證甲狀腺術(shù)后病人創(chuàng)面軟組織的強(qiáng)大重吸收能力,選擇是否常規(guī)放置引流管及引流管的安全拔出時(shí)間,為甲狀腺疾病快速康復(fù)醫(yī)學(xué)的臨床研究及實(shí)踐提供參考。[方法]收集2013年9月-2014年4月間在昆明醫(yī)科大學(xué)第一附屬醫(yī)院甲狀腺疾病診治中心擬行開(kāi)放性甲狀腺切除術(shù),符合入組標(biāo)準(zhǔn)的674例患者進(jìn)行前瞻性研究分析,隨機(jī)分為A(0h不放置引流管組)、B (4h)、C (8h)、D (16h)、E (24h)、F (48h)拔管組、G(測(cè)每小時(shí)引流液)、H(分析引流液性狀),I(引流管末端送培養(yǎng)E+F)組,每組病例均大于30例,各組病例手術(shù)均由同一治療組醫(yī)師進(jìn)行,依據(jù)最新的ATA指南,采用該治療中心標(biāo)準(zhǔn)甲狀腺切除術(shù)式。記錄術(shù)后各個(gè)時(shí)間段引流量、術(shù)后各組總引流量及分析時(shí)間段引流液性狀,觀察細(xì)菌培養(yǎng)情況及術(shù)后切口愈合情況,所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,對(duì)比各組有無(wú)差異,及描繪引流液性狀變化趨勢(shì)圖。[結(jié)果]：整個(gè)研究過(guò)程中,未出現(xiàn)術(shù)后出血和呼吸困難并發(fā)癥,有1例因引流管堵塞排除實(shí)驗(yàn)。1、測(cè)每小時(shí)引流液組：提出小時(shí)引流液及時(shí)間段引流液的概念,隨著時(shí)間推移,小時(shí)引流液的量逐漸下降,約在術(shù)后12小時(shí)甲狀腺術(shù)后的病人引流液引出量趨于平穩(wěn);2、分析引流液性狀變化規(guī)律組：隨著時(shí)間延長(zhǎng),約在術(shù)后12小時(shí)甲狀腺術(shù)后病人引流液中紅細(xì)胞計(jì)數(shù)降低速度趨于平穩(wěn)；白細(xì)胞計(jì)數(shù)在4小時(shí)達(dá)高峰,之后大體不變。3、引流管末端的細(xì)菌培養(yǎng)情況：末端在24小時(shí)拔出組未見(jiàn)細(xì)菌生長(zhǎng),48小時(shí)組可見(jiàn)3例培養(yǎng)出細(xì)菌,結(jié)果為表皮葡萄球菌(+),組間比較有差異,存在統(tǒng)計(jì)學(xué)意義,P=0.019。4、各時(shí)間段拔出引流管組切口愈合情況：674例患者中,1例因引流管堵塞排除實(shí)驗(yàn),進(jìn)入統(tǒng)計(jì)的673例患者中,有670例患者的切口全部甲級(jí)愈合,有3例乙級(jí)愈合。甲級(jí)愈合患者中均無(wú)創(chuàng)面血腫形成,其中15例引流管口外滲液,經(jīng)積極外科換藥后,全部愈合：0h組中有3例在術(shù)后2-3天內(nèi)出現(xiàn)皮下積液,持續(xù)1-2天,經(jīng)外科換藥后消失；4h組有4例在拔出引流管后1-2天內(nèi)引流口出現(xiàn)外滲積液,經(jīng)換藥后,此癥狀逐漸消失；8h組有3例在拔出引流管后2-3天內(nèi)引流口出現(xiàn)外滲積液,經(jīng)換藥后,此癥狀逐漸消失；16h組有1例在拔出引流管后2天引流口出現(xiàn)外滲積液,經(jīng)換藥后,此癥狀逐漸消失；24h組有2例在拔出引流管后1-2天內(nèi)引流口出現(xiàn)外滲積液,經(jīng)換藥后,此癥狀逐漸消失；48h組有2例在拔出引流管后1-2天內(nèi)引流口出現(xiàn)外滲積液,經(jīng)換藥后,此癥狀逐漸消失；3例乙級(jí)愈合病例,經(jīng)換藥后癥狀消失,切口愈合。六組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義,P=-0.787。[結(jié)論]：甲狀腺創(chuàng)面疏松軟組織具有的強(qiáng)大重吸收功能,可以與創(chuàng)面滲出速度相平衡,大部分病例術(shù)后不放置引流管是安全的,剩余病例應(yīng)個(gè)體化選擇性留置引流管。若放置引流管,術(shù)后12小時(shí)是安全拔管時(shí)間,促進(jìn)甲狀腺外科快速康復(fù)的發(fā)展。
[Abstract]:[Objective] to choose the case of first open thyroid surgery as the research object. Through the determination of the related indexes of postoperative flow rate, red blood cell, leukocyte and drainage tube end bacteria culture, the trend map of the change of drainage volume and the change pattern of leukocyte infection factors after primary thyroid operation were constructed, and further pass through The effect of different extubation time on the healing of the incision, the strong reabsorption ability of the soft tissue in the patients after thyroid surgery, the selection of the regular placement of drainage tube and the safe pulling time of the drainage tube, provide reference for the clinical study and practice of the rapid rehabilitation medicine for thyroid disease. [Methods] collect the April -2014 year in September 2013. Open thyroidectomy was planned to be performed at the First Affiliated Hospital of Kunming Medical University. 674 patients who were in accordance with the criteria were randomly divided into A (0h without drainage tube group), B (4h), C (8h), D (16h), E (24h), F (48h) extubation group. The end of the flow tube was sent to the E+F group. Each case was more than 30 cases. All the cases were performed by the same treatment group. According to the latest ATA guide, the standard thyroidectomy was used in the treatment center. The flow rate of each time after the operation was recorded, the total flow rate of each group and the characteristics of the drainage fluid were analyzed, and the culture condition of the bacteria was observed. Status and postoperative wound healing, statistical analysis of the data, compared with each group, and depicting the trend map of the characteristics of the drainage. [results] there were no postoperative complications of bleeding and dyspnea during the whole study. 1 cases were excluded from the experimental.1 due to drainage tube blockage, and the hourly drainage group was measured, and the hourly drainage fluid was put forward. The concept of the drainage fluid in the time period, the amount of the drainage fluid decreased gradually with time, about 12 hours after the operation of the patients after the thyroidectomy, the drainage volume of the drainage fluid tended to be stable; 2, the analysis of the variation of the characteristics of the drainage fluid: with the time prolonging, the erythrocyte count decreased in the drainage fluid after the operation 12 hours after the operation. The white blood cell count reached the peak at 4 hours, after which the bacteria culture at the end of the drainage tube was unchanged by.3, and the bacteria culture at the end of the drainage tube was not seen in the 24 hour group. In the 48 hour group, the bacteria were found in 3 cases. The result was that the Staphylococcus epidermidis (+) was different between the groups. There was statistical significance, P=0.019.4, drawing out drainage in each time period. Of the 674 patients, 1 of the 674 cases were excluded because of drainage tube blockage. Among the 673 patients who entered the statistics, all of the 670 patients were healed with grade A and 3 cases of grade B healing. There were no wound hematoma in the patients with grade a healing, of which 15 cases were healed after positive surgical replacement, and all healed in group 0h. There were 3 cases of subcutaneous effusion in 2-3 days after the operation, which lasted for 1-2 days and disappeared after surgical dressing. 4 cases in group 4H had exudate effusion within 1-2 days after pulling out the drainage tube. After changing the medicine, the symptoms disappeared gradually, and 3 cases in group 8h had the drainage and exudate effusion within 2-3 days after pulling out the drainage tube, and the symptom disappeared gradually after changing the medicine. 1 In group 6h, 1 cases had exudate effusion in the drainage mouth 2 days after pulling out the drainage tube. After changing the medicine, the symptoms disappeared gradually. In group 24h, 2 cases had exudate effusion in the drainage mouth within 1-2 days after pulling out the drainage tube. After changing the medicine, the symptoms disappeared gradually. In group 48h, the drainage mouth appeared exudate effusion within 1-2 days after pulling out the drainage tube, and after changing the medicine, the drug was changed. The symptoms gradually disappeared; 3 cases of second grade healing, the symptoms disappeared and the incision healed. There was no statistical difference between the six groups. P=-0.787.[conclusion: the strong reabsorption function of the loose soft tissue of the thyroid wound is balanced with the exudation speed of the wound, and the rest of the large cases is safe without placing the drainage tube after operation. Cases should be individualized and indwelling drainage tube. If the drainage tube is placed, the safe extubation time should be 12 hours after operation, so as to promote the rapid recovery of thyroid surgery.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R653

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本文編號(hào)：2116954