The Curative Effect of Intrathoracic Injection of Thrombin Combined with Drainage Tube Suspension in the Treatment of Refractory Pneumothorax
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摘要:
目的 探讨胸腔内注射凝血酶、引流管悬吊联合治疗难治性气胸的临床疗效，并观察该治疗方案对患者漏口闭合时间、发热发生率的影响。 方法 前瞻性选取2020年6月至2022年6月医院106例难治性气胸患者，依据随机数字表法将其分为对照组53例与研究组53例，对照组采用胸腔内注射凝血酶+常规胸腔闭式引流治疗，研究组采用胸腔内注射凝血酶+引流管悬吊治疗，观察2组临床疗效、留管时间、漏口闭合时间、住院时间、并发症（发热、胸膜粘连、纵隔气肿），对比2组治疗前、后肺功能指标[肺活量（VC）、残气量（RV）、肺一氧化碳弥散量（DLCO）、肺总量（TLC）]、血气分析指标[动脉血氧分压（PaO2）、二氧化碳分压（PCO2）、氧合指数（PaO2/FiO2）、血氧饱和度（SaO2）]、6 min行走试验（6MWT）、Borg呼吸困难指数。 结果 治疗后，研究组总有效率高于对照组（P < 0.05）；研究组留管时间、漏口闭合时间、住院时间短于对照组（P < 0.05）；研究组并发症少于对照组（P < 0.05）；治疗后，2组VC、RV、DLCO、TLC高于治疗前，且与对照组相比，研究组更高（P < 0.05）；治疗后，2组PaO2、PaO2/FiO2、SaO2高于治疗前，PaCO2、Borg呼吸困难指数低于治疗前，6MWT长于治疗前，且与对照组相比，研究组变化幅度更大（P < 0.05）。 结论 胸腔内注射凝血酶联合引流管悬吊治疗难治性气胸效果显著，可改善患者肺功能指标、血气指标，减轻呼吸困难症状，提高运动耐量，缩短恢复时间，且不会增加并发症。 Abstract:Objective To explore the clinical efficacy of intrathoracic injection of thrombin combined with drainage tube suspension in the treatment of refractory pneumothorax, and to observe the effect of this treatment scheme on the closure time of leakage and the incidence of fever. Methods From June 2020 to June 2022, 106 patients with refractory pneumothorax were prospectively selected and divided into a control group （53 cases） and a study group （53 cases） according to random number table. The control group was treated with intrathoracic injection of thrombin+conventional closed thoracic drainage, while the study group was treated with intrathoracic injection of thrombin+drainage tube suspension. The clinical efficacy, retention time, leakage closure time, hospitalization time, complications （fever, pleural adhesion, mediastinal emphysema） of the 6MWT groups were observed, and the lung function indexes [vital capacity （VC）, residual volume （RV）, pulmonary carbon monoxide diffusion （DLCO）, total lung volume （TLC）] and blood gas analysis indexes [arterial oxygen partial pressure （PCO2） before and after treatment were compared. Results After the treatment, the total effective rate of the study group was higher than that of the control group （P < 0.05）. The retention time, leakage closure time and hospitalization time of the study group were shorter than those of the control group （P < 0.05）. The complications in the study group were less than those in the control group （P < 0.05）. After the treatment, the levels of VC, RV, DLCO and TLC in the two groups were higher than those before the treatment, and higher in the study group than in the control group （P < 0.05）. After the treatment, PaO2, PaO2/FiO2, and SaO2 in the two groups were higher than those before the treatment, PaCO2 _and Borg dyspnea index were lower than those before treatment, and 6MWT was longer than that before the treatment, and compared with the control group, the change range in the study group was greater （P < 0.05）. Conclusion Thoracic injection of thrombin combined with drainage tube suspension is effective in the treatment of refractory pneumothorax, which can improve the pulmonary function index and blood gas index, relieve dyspnea symptoms, improve exercise tolerance, shorten the recovery time, and will not increase complications. -
表 1 2组一般资料比较[n（%）/（$\bar x \pm s $）]
Table 1. Comparison of two groups of general data[n（%）/（$ \bar x \pm s$）]
指标 研究组（n=53） 对照组（n=53） χ2/t P 性别 男 29（54.72） 27（50.94） 0.151 0.697 女 24（45.28） 26（49.06） 年龄（岁） 48.69±6.35 49.18±6.57 0.390 0.697 糖尿病 7（13.21） 5（9.43） 0.376 0.540 高血压 16（30.19） 18（33.96） 0.173 0.677 吸烟史 17（32.08） 14（26.42） 0.410 0.522 饮酒史 22（41.51） 20（37.74） 0.158 0.619 
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表 2 2组临床疗效比较[n（%）]
Table 2. Comparison of clinical efficacy between two groups [n（%）]
组别 显效 有效 无效 总有效 研究组（n=53） 46（86.79）* 5（9.43）* 2（3.77）* 51（96.23）* 对照组（n=53） 32（60.38） 12（22.64） 9（16.98） 44（83.02） Z/χ2 3.121 4.970 P 0.002 0.026 注：与对照组比较，*P < 0. 05。
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表 3 2组留管时间、漏口闭合时间、住院时间比较（$\bar x \pm s $，d）
Table 3. Comparison of retention time，leakage closure time and hospitalization time between the two groups（$\bar x \pm s $，d）
组别 留管时间 漏口闭合时间 住院时间 研究组（n=53） 1.83±0.66* 1.86±0.83* 7.13±2.18* 对照组（n=53） 2.52±0.79 2.34±0.91 9.17±2.24 t 4.880 2.837 4.751 P <0.001 0.006 <0.001 注：与对照组比较，*P < 0. 05。
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表 4 2组并发症比较[n（%）]
Table 4. Comparison of complications between two groups [n（%）]
组别 发热 胸膜粘连 纵隔气肿 总发生 研究组（n=53） 1（1.89） 0（0.00） 0（0.00） 1（1.89） 对照组（n=53） 3（5.66） 2（3.77） 3（5.66） 8（15.09） χ2 0.442 P 0.506
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表 5 2组治疗前、后肺功能指标比较（$ \bar x $±s）
Table 5. Comparison of lung function indexes before and after treatment between two groups（$\bar x \pm s $）
组别 VC（L） RV（L） DLCO[mL/（min·mmHg）] TLC（L） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 研究组（n=53） 3.32±0.42 4.03±0.39* 1.06±0.21 1.54±0.23* 11.47±1.63 17.59±2.13* 4.22±0.58 5.10±0.52* 对照组（n=53） 3.24±0.46 3.76±0.41* 1.03±0.18 1.36±0.20* 11.56±1.49 15.61±2.32* 4.19±0.54 4.71±0.48* t 0.935 3.474 0.790 4.299 0.297 4.577 0.276 4.012 P 0.352 0.001* 0.432 <0.001 0.767 <0.001* 0.783 <0.001* 与同组治疗前比较，*P < 0.05。
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表 6 2组治疗前、后血气分析指标比较（$ \bar x $±s）
Table 6. Comparison of blood gas analysis indexes between two groups before and after treatment（$\bar x \pm s $）
组别 PaO2（mmHg） PaCO2（mmHg） PaO2/FiO2 SaO2（%） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 研究组（n=53） 66.78±7.64 92.53±4.16* 48.51±6.32 35.46±5.19* 304.69±42.58 366.59±35.60* 78.49±7.12 93.86±3.42* 对照组（n=53） 67.13±8.12 88.25±5.38* 48.29±6.18 39.22±5.41* 303.51±45.27 343.18±31.24* 77.93±7.63 90.57±4.58* t 0.229 4.582 0.181 3.651 0.138 3.598 0.391 4.190 P 0.820 <0.001* 0.857 <0.001* 0.890 0.001* 0.697 <0.001* 与同组治疗前比较，*P < 0.05。
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表 7 2组治疗前、后6MWT、Borg呼吸困难指数比较（$ \bar x $±s）
Table 7. Comparison of 6MWT and Borg Dyspnea Index between the two groups before and after treatment（$\bar x \pm s $）
组别 6MWT（m） Borg呼吸困难指数（分） 治疗前 治疗后 治疗前 治疗后 研究组（n=53） 306.54±12.13 391.43±13.57* 7.02±1.46 2.32±0.78* 对照组（n=53） 308.26±12.68 379.54±11.79* 6.96±1.51 3.05±0.97* t 0.714 4.815 0.208 4.270 P 0.477 <0.001* 0.836 <0.001* 与同组治疗前比较，*P < 0.05。
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