完全胸腔镜与传统开胸肺叶切除术对患者动脉血气影响的研究

摘要

目的：观察并对比完全胸腔镜下肺叶切除术与传统开胸肺叶切除术对患者动脉血气的影响及程度。方法回顾性分析2013年5月~2015年3月间本院胸外科行肺叶切除术的65例患者病历,根据手术方式分为完全胸腔镜组35例和传统组30例,胸腔镜组患者采用完全胸腔镜下切除肺叶,传统组采取传统开胸肺叶切除术,比较两组患者术前及术后1天、3天、7天时氧分压( PaO2)、二氧化碳分压( PaCO2)、PH值、剩余碱( BE)、标准碳酸氢盐( SB)等动脉血气数据。结果两组患者术后第1天、第3天动脉氧分压均不同程度下降,术后第7天各项指标回升或接近术前标准。术后第1天完全胸腔镜组患者PaO2(76．32±4．01) mm-Hg显著高于传统组(68．27±3．21) mmHg ( t=8．832 P<0．001),完全胸腔组患者 EB 值(-2．58±1．09) mmol/L也显著高于传统组(-2．07±0．93) mmol/L(t=2．011 P=0．049),PaCO2、SB、PH两组比较差异无统计学意义( P>0．05)。术后第3天胸腔镜组PaO2(68．98±4．02) mmHg亦明显高于传统组(63．92±3．56) mmHg(t=5．33 P<0．001),PaCO2、EB、SB、PH等指标两组比较差异无统计学意义(P>0．05)。术后第7天两组PaO2、PaCO2、EB、SB、PH等指标差异均无统计学意义(P>0．05)。结论完全胸腔镜肺叶切除术与传统开胸肺叶切除术对患者术后动脉血气均会产生一定影响,完全胸腔镜肺叶切除术在术后早期对患者动脉血气影响显著小于传统开胸肺叶切除术,后期无明显差异。%Objective To observe and compare the effect between totally thoracoscopic lobectomy and con-ventional thoracotomy lobectomy on patients’ arterial blood gas. Methods A retrospective analysis was conducted on 65 cases underwent thoracic surgery from May 2013 to March 2015. All cases were divided into the totally video-assisted thoracoscopic surgery (VATS) group (n=35) and the conventional group (n=30) according to operation methods. The VATS group was given completely thoracoscopic lobectomy, and the conventional group was applied with conventional thoracotomy lobectomy. Their oxygen partial pressure ( PaO2 ) , carbon dioxide partial pressure (PaCO2), pH and base excess (BE), and standard bicarbonate (SB) preoperatively and 1, 3 and 7 days after the treatment were detected and compared between the two groups. Results The level of PaO2 decreased 1 and 3 days after operation, and the indexes at the 7th day recovered or approached to the standard in the two groups. The level of PaO2 was (76. 32+4. 01) mmHg at the 1st day in the VATS group, which was significantly higher than that in the conventional group (68. 27+3. 21) mmHg (t=8. 832, P<0. 001). The value of EB was ( -2. 58+1. 09) mmol/L in the VATS group, and ( -2. 07+0. 93) mmol/L in the conventional group (t=2. 011, P=0. 049). There was no significant difference in PaCO2, SB and PH between the two groups (P>0. 05). 3 days after operation, the level of PaO2 was (68. 98 +4. 02) mmHg in the VATS group, significantly higher than that in the conventional group (63. 92+3. 56) mmHg (t=5. 33, P<0. 001). There was no significant difference in PaCO2, EB, SB and pH be-tween the two groups 7 days after operation (P>0. 05). Conclusion The totally VATS and conventional thoracoto-my lobectomy both have certain effect on patients' arterial blood gas after operation. The totally VATS surgery shows a bigger influence on arterial blood gas at the early postoperative period than the conventional thoracotomy lobectomy dose, but the two have the similar long-term effect.