标题：单孔胸腔镜手术治疗自发性气胸的疗效及对患者氧化应激反应及血清NPY、SP、PGE2水平的影响

      作者：陈岳威，付兵，曹怡    成都中医药大学附属医院心胸外科，四川 成都 610075

      卷次： 2021年32卷7期

      【摘要】 目的 探讨单孔胸腔镜手术治疗自发性气胸的疗效及对患者氧化应激反应及血清神经肽 Y(NPY)、P物质(SP)、前列腺素E2 (PGE2)水平的影响。方法 选取2018年4月至2020年9月成都中医药大学附属医院心胸外科收治的自发性气胸患者103例，按治疗方案不同分为单孔组(采取单孔胸腔镜手术) 52例和传统组(采取传统三孔胸腔镜手术) 51例。比较两组患者围术期手术有关指标、术后6 h、1 d、2 d、3 d的疼痛评分(VAS)与术前、术后1 d、3 d的血气指标[动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)]、血清氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]、NPY、SP、PGE2水平，统计并发症发生率。结果 单孔组患者的手术时间、住院时间、胸管引流时间分别为(55.59±8.47) min、(3.04±0.39) d、(2.68±0.26) d，明显短于传统组的(63.04±10.21) min、(4.85±0.63) d、(4.07±0.51) d，术中出血量、术后引流量与术后6 h、1 d、2 d、3 d的VAS评分分别为(26.53±7.61)mL、(128.39±26.85) mL、(5.07±0.74)分、(4.38±0.49)分、(3.19±0.34)分、(2.21±0.28)分，明显低于传统组的(45.49±10.24) mL、(207.14±41.62) mL、(6.49±0.92)分、(5.29±0.64)分、(4.32±0.50)分、(3.04±0.39)分，差异均有统计学意义(P<0.05)；单孔组患者术后 1 d、3 d的PaCO2水平分别为(40.52±8.38) mmHg、(35.82±6.49) mmHg，明显低于传统组的(46.03±9.69) mmHg、(40.43±7.72) mmHg，PaO2水平分别为(83.48±10.92) mmHg、(90.64±8.25) mmHg，明显高于传统组的(76.24±12.35) mmHg、(84.96±9.31) mmHg，差异均具有统计学意义(P<0.05)；单孔组患者术后 1 d、3 d的血清 SOD水平分别为(38.03±5.41) U/mL、(41.26±6.57) U/mL，明显高于传统组的(32.56±3.69) U/mL、(36.85±5.41) U/mL，MDA与NPY、SP、PGE2水平分别为(7.74±2.06) nmol/L、(6.48±1.85) nmol/L、(136.94±16.36) pg/mL、(119.26±13.04) pg/mL、(1.80±0.37) μg/mL、(1.49±0.28) μg/mL、(195.79±28.44) pg/mL、(162.41±21.35) pg/mL，明显低于传统组的(9.80±3.14) nmol/L、(7.92±2.13) nmol/L、(174.37±20.24) pg/mL、(142.15±15.72) pg/mL、(2.62±0.49) μg/mL、(1.93±0.42) μg/mL、(247.02±35.53) pg/mL、(203.59±25.42) pg/mL，差异均有统计学意义(P<0.05)；单孔组患者的并发症发生率为 3.85%，明显低于传统组的17.65%，差异有统计学意义(P<0.05)。结论 应用单孔胸腔镜手术治疗自发性气胸可显著降低手术创伤与疼痛程度，减轻氧化应激反应，减少疼痛介质分泌，改善血气情况，促进术后恢复，减少并发症。
      【关键词】 自发性气胸；单孔胸腔镜手术；VAS评分；氧化应激反应；疼痛介质
      【中图分类号】 R655 【文献标识码】 A 【文章编号】 1003—6350（2021）07—0855—05

Efficacy of single-port thoracoscopic surgery for spontaneous pneumothorax and its effect on oxidative stressresponse and serum NPY, SP, and PGE2 levels in patients.
CHEN Yue-wei, FU Bing, CAO Yi. Department ofCardiothoracic Surgery, the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075,Sichuan, CHINA
【Abstract】 Objective To investigate the efficacy of single-port thoracoscopic surgery for spontaneous pneu-mothorax and its effect on oxidative stress response and serum neuropeptide Y (NPY), substance P (SP), and prosta-glandin E2 (PGE2) levels in patients. Methods From April 2018 to September 2020, 103 patients with spontaneouspneumothorax admitted to the Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University ofTraditional Chinese Medicine were selected. According to different treatment options, they were divided into 52 casesin the single port group (single-port thoracoscopic surgery) and 51 cases in the traditional group (traditional three-portthoracoscopic surgery). The perioperative indexes, visual analogue scale (VAS) scores at 6 h, 1 d, 2 d, and 3 d after op-eration, blood gas indexes (partial pressure of carbon dioxide in artery [PaCO2], partial pressure of oxygen in artery[PaO2]) and serum oxidative stress indexes (superoxide dismutase [SOD], malondialdehyde [MDA]), NPY, SP, PGE2levels before and 1 d, 3 d after operation were compared between the two groups. And the incidence of complicationswas calculated. Results The operation time, hospitalization time, and the drainage time of the chest tube in the sin-gle port group were (55.59±8.47) min, (3.04±0.39) d, and (2.68±0.26) d, respectively, which were significantly short-er than corresponding (63.04±10.21) min, (4.85±0.63) d, (4.07±0.51) d of the traditional group (all P<0.05). The intra-operative blood loss, postoperative drainage volume, and VAS scores at 6 h, 1 d, 2 d, and 3 d after surgery were