新型胸引管在单孔胸腔镜下肺癌根治术ERAS中的应用价值

孙宇 李束 施谷平 马兴杰

[摘要] 目的 觀察在单孔胸腔镜下肺癌根治术中12 F猪尾巴管作为新型胸引管在加速康复外科（ERAS）中的应用价值。 方法 研究纳入2018年1月至2020年12月我院收治的200例肺癌患者，均接受单孔胸腔镜下根治术，利用随机法分组，观察组100例患者予以改良型ERAS肋间神经阻滞+12 F猪尾巴管作为新型胸引管留置，对照组100例予以生理盐水20 mL阴性对照+传统胸引管，比较两组术后疼痛程度、引流效果、住院时间及并发症情况。结果 两组术后疼痛程度评分比较，观察组患者术后1、24、48、72 h评分均低于对照组，差异有统计学意义（P<0.05）;观察组患者引流时间短于对照组，且术后24、48 h引流量均少于对照组，差异有统计学意义（P<0.05）;观察组术后并发症总发生率明显低于对照组，差异有统计学意义（P<0.05）;观察组住院时间短于对照组，差异有统计学意义（P<0.05）。 结论 在ERAS基础上，对单孔胸腔镜下肺癌根治术患者应用猪尾巴管作为新型胸引管，可有效减轻患者术后疼痛，减少术后引流量，缩短引流时间，有利于预防术后并发症，促使患者快速康复，早日出院，减轻家庭经济负担，值得推广。

[关键词] 快速康复外科;肺癌;单孔胸腔镜下根治术;猪尾巴管

[中图分类号] R734.2          [文献标识码] B          [文章编号] 1673-9701（2021）34-0101-04

[Abstract] Objective To observe the application value of 12 F pig-tail tube as a novel thoracic drainage tube in Enhanced Recovery After Surgery（ERAS） during uniportal thoracoscopic radical resection of lung cancer. Methods A total of 200 patients with lung cancer admitted to our hospital from January 2018 to December 2020 were included in the study. All patients received uniportal thoracoscopic radical resection of lung cancer and were randomly divided into the observation group（n=100） and the control group（n=100）. The observation group was treated with intercostal nerve block in modified ERAS and 12 F pig-tail tube as a new type of thoracic intubation， while the control group was treated with 20 mL normal saline as the negative control and traditional thoracic intubation. The postoperative pain， drainage effect， hospitalization time and complications of the two groups were compared. Results The score of postoperative pain were significantly lower in the observation group 1 h， 24 h， 48 h and 72 h after operation than those in the control group， with statistically significant differences（P<0.05）. The drainage time was shorter in the observation group than that in the control group， and the drainage volumes 24 h and 48 h after operation were both less in the observation group than those in the control group， with statistically significant differences（P<0.05）. The total incidence rate of postoperative complications was significantly lower in the observation group than that in the control group， with statistically significant difference（P<0.05）. The hospitalization time was shorter in the observation group than that in the control group， with statistically significant difference（P<0.05）. Conclusion On the basis of ERAS， pig-tail tube as a new type of thoracic drainage tube can effectively relieve postoperative pain， reduce postoperative drainage volume， shorten drainage time， help prevent postoperative complications and promote faster recovery， thus helping patients discharge from hospital as soon as possible， and reducing family economic burden for patients undergoing uniportal thoracoscopic radical resection of lung cancer， which is worth popularization.

[Key words] Enhanced recovery after surgery; Lung cancer; Uniportal thoracoscopic radical resection; Pig-tail tube

加速康复外科（Enhanced recovery after surgery，ERAS）综合多学科优势，属于一种新型的护理与医疗理念，自2001年丹麦外科医师Kehlet提出以来，被广泛应用于临床，并取得较为显著成绩[1]。ERAS的目的是根据循证医学证据，在围术期积极采取一系列优化处理方式、方法，降低围术期患者心理应激、生理应激，以减轻患者手术创伤性，加速术后康复，预防术后并发症发生。目前，ERAS应用于多个领域，已有大量研究证实其可行性与安全性，但在胸外科方面临床相关报道较少。在胸外科手术治疗中，术后疼痛是影响患者术后康复的重要因素之一[2]。造成术后疼痛因素众多，如手术创伤、引流管留置刺激等;如何更好地缓解患者术后疼痛，是ERAS胸外科需要解决的问题[3]。本研究对2018年1月至2020年12月本院收治的100例单孔胸腔镜下肺癌根治术患者，应用12 F猪尾巴管作为新型胸引管留置引流，观察其应用价值，现报道如下。……