胸腔镜下肺减容术治疗老年重度慢阻肺疗效及对患者通气-灌注的影响
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摘要
目的:探讨胸腔镜下肺减容术(VATS)治疗老年重度慢性阻塞性肺疾病(COPD)的临床疗效及其对患者通气-灌注(V/Q)不匹配的影响。方法:将76例老年COPD患者随机分为观察组与对照组,每组38例。观察组行VATS治疗,对照组行常规开胸肺减容术治疗。比较两组手术情况及术后并发症,观察并比较手术前后肺功能指标、肺V/Q、6min步行距离(6 MWT)、圣乔治呼吸问卷(SGRQ)评分。结果:观察组的手术时间较对照组明显延长,但观察组术中出血量、胸管留置时间、镇痛时间及住院时间显著低于对照组(P<0.05);观察组术后并发症发生率较对照组明显降低(P<0.05);术后3个月,观察组的肺V/Q测定结果显著低于对照组(P<0.05);术后3个月,观察组的FEV1、FVC及6MWT显著高于对照组,RV、TCL及SGRQ评分显著低于对照组(P<0.05),但术后12个月两组肺功能指标、6MWT和SGRQ评分比较差异无统计学意义(P>0.05)。结论:VATS肺减容术治疗老年重度COPD疗效确切,能够改善肺V/Q不匹配,减少肺容积,改善患者的生活质量。
Objective:To investigate the clinical efficacy of video-assisted thoracoscopic lung volume reduction surgery(VATS)in the treatment of elderly patients with severe chronic obstructive pulmonary disease(COPD)and its influence on ventilation-perfusion(V/Q)mismatch.Methods:76 casesof elderly COPD patients were randomly divided into observation group and control group,with 38 cases in each group.The observation group patients accepted VATS,the control group patients accepted conventional lung volume reduction surgery.The surgical situations and postoperative complications were compared between the two groups,thelung function index,lung V/Q,6-minute walking distance(6 MWT)and St.George's Respiratory Questionnaire(SGRQ)scores were observed and compared.Results:The operation time of the observation group was significantly longer than that of the control group,but the intraoperative bleeding,the time of indwelling chest tube,analgesic time and hospital stay time in the observation group were significantly lower than those in the control group(P<0.05).The postoperative complications rate in the observation group was significantly lower than that of the control group(P<0.05);3 months after surgery,the pulmonary V/Q results in the observation group were significantly lower than the control group(P<0.05);3 months after surgery,the FEV1,FVC and 6 MWT in the observation group were significantly higher than the control group,while RV,TCL and SGRQ score were significantly lower(P<0.05),there were no significant differencesof lung function indexes,6 MWT and SGRQ scores between the two groups(P>0.05).Conclusion:VATS lung volume reduction surgery is effective in the treatment of elderly patients with severe,which can improve lung V/Q mismatch,reduce lung volume and improve quality of life of patients.
Objective:To investigate the clinical efficacy of video-assisted thoracoscopic lung volume reduction surgery(VATS)in the treatment of elderly patients with severe chronic obstructive pulmonary disease(COPD)and its influence on ventilation-perfusion(V/Q)mismatch.Methods:76 casesof elderly COPD patients were randomly divided into observation group and control group,with 38 cases in each group.The observation group patients accepted VATS,the control group patients accepted conventional lung volume reduction surgery.The surgical situations and postoperative complications were compared between the two groups,thelung function index,lung V/Q,6-minute walking distance(6 MWT)and St.George's Respiratory Questionnaire(SGRQ)scores were observed and compared.Results:The operation time of the observation group was significantly longer than that of the control group,but the intraoperative bleeding,the time of indwelling chest tube,analgesic time and hospital stay time in the observation group were significantly lower than those in the control group(P<0.05).The postoperative complications rate in the observation group was significantly lower than that of the control group(P<0.05);3 months after surgery,the pulmonary V/Q results in the observation group were significantly lower than the control group(P<0.05);3 months after surgery,the FEV1,FVC and 6 MWT in the observation group were significantly higher than the control group,while RV,TCL and SGRQ score were significantly lower(P<0.05),there were no significant differencesof lung function indexes,6 MWT and SGRQ scores between the two groups(P>0.05).Conclusion:VATS lung volume reduction surgery is effective in the treatment of elderly patients with severe,which can improve lung V/Q mismatch,reduce lung volume and improve quality of life of patients.
引文
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[13]康世荣,曹春莉,马英,等.肺减容术在重度肺气肿治疗中的应用[J].实用临床医药杂志,2015,19(7):87-90.
[2]代岩,金博,许学宗.舒血宁注射液联合孟鲁司特钠对AECOPD患者肺功能及血清4-HNE、bFGF、VCAM-1、TGF-β1水平变化的影响[J].陕西中医,2018,39(8):1037-1039,1047.
[3]赵旭东,石开虎,吴君旭,等.肺减容术后中期肺功能变化和生活质量评估[J].中华胸心血管外科杂志,2014,30(1):27-29.
[4]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[5]王君,赵玉才,马春平.电视胸腔镜双侧肺减容术治疗慢性阻塞性肺气肿效果观察[J].山东医药,2013,53(16):35-36.
[6]马金山,陈康,肖开提,等.电视胸腔镜下肺减容术治疗重度慢性阻塞性肺气肿68例[J].中华胸心血管外科杂志,2013,29(8):457-459,476.
[7]张晓洁,陈志明,张秋实,等.电视胸腔镜下肺减容术对重度慢性阻塞性肺气肿患者炎性因子、肺功能及生活质量的影响[J].中国内镜杂志,2016,22(7):14-17.
[8]马金山,陈康,肖开提,等.电视胸腔镜下肺减容术治疗重度慢性阻塞性肺气肿68例[J].中华胸心血管外科杂志,2013,29(8):457-459,476.
[9]邹强,赵夏,黄云,等.胸腔镜与常规切口肺减容术治疗重度慢性阻塞性肺气肿患者的对比研究[J].西部医学,2016,28(3):389-392.
[10]孙丽昕,王荣福.终末期肺气肿肺减容术的各种影像学检查比较及进展[J].标记免疫分析与临床,2016,23(6):700-703.
[11]Bajc M.Potential of hybrid V/P SPECT-low-dose CT in lung diagnostics[J].Breathe,2012,9(1):48-60.
[12]Lee SW,Lee SM,Shin SY,et al.Mprovement in ventilation-perfusion mismatch after bronchoscopic lung volume reduction:quantitative image analysis[J].Radiology,2017,285(1):250-260.
[13]康世荣,曹春莉,马英,等.肺减容术在重度肺气肿治疗中的应用[J].实用临床医药杂志,2015,19(7):87-90.