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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2018, Vol. 05 ›› Issue (01) : 32 -36. doi: 10.3877/cma.j.issn.2095-8773.2018.01.07

所属专题： 文献；

论著

使用硝酸甘油控制性降压对食管癌开胸术后胸腔引流量的影响
朱晓磊1, 朱自江2,†(), 王文昊2, 庞瑶2   
  1. 1. 730000　兰州，甘肃中医药大学临床医学院；730000　兰州，甘肃省人民医院胸外科
    2. 730000　兰州，甘肃省人民医院胸外科
  • 收稿日期:2017-07-17 出版日期:2018-02-28
  • 通信作者: 朱自江

Effects of nitroglycerin-controlled hypotension on thoracic drainage after esophagectomy

Xiaolei Zhu1, Zijiang Zhu2,†(), Wenhao Wang2, Yao Pang2   

  1. 1. Medical School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China; Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou 730000, China
    2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou 730000, China
  • Received:2017-07-17 Published:2018-02-28
  • Corresponding author: Zijiang Zhu
  • About author:
    Corresponding author: Zhu Zijiang, Email:
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朱晓磊, 朱自江, 王文昊, 庞瑶. 使用硝酸甘油控制性降压对食管癌开胸术后胸腔引流量的影响[J/OL]. 中华胸部外科电子杂志, 2018, 05(01): 32-36.

Xiaolei Zhu, Zijiang Zhu, Wenhao Wang, Yao Pang. Effects of nitroglycerin-controlled hypotension on thoracic drainage after esophagectomy[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(01): 32-36.

目的

观察食管癌根治术后应用硝酸甘油控制性降压对术后胸腔引流量及胸腔引流管拔除时间的影响。

方法

将甘肃省人民医院胸外科2015年3月—2017年4月行经左胸食管癌根治术的128例患者随机分为两组。试验组(n＝64)：术后48 h内以0.01%的硝酸甘油溶液微量泵泵入行控制性降压，血压严格控制在90～100 mmHg/60～70 mmHg范围内；对照组(n＝64)：术后48 h内未行硝酸甘油控制性降压，血压波动在110～148 mmHg/70～102 mmHg。比较两组患者的术前临床资料，以及术后第1、3、5、7、9天的胸腔引流量及胸腔引流总量、术后胸腔引流管拔除时间。

结果

两组患者的年龄、性别、病变部位、病理类型及TNM分期等临床资料比较差异均无统计学意义(P>0.05)。试验组患者的术后胸腔引流总量、胸腔引流管拔除时间和住院时间均显著少于对照组，差异有统计学意义[(939±134)ml vs (1 203±146)ml，P<0.01；(8.7±1.1)d vs (10.6±1.3)d，P<0.01；(9.5±1.2)d vs(11.2±2.4)d]。

结论

经左胸食管癌根治术后应用硝酸甘油控制性降压可有效减少胸腔引流总量，能在一定程度上缩短胸腔引流管的拔除时间和住院时间。

关键词: 食管癌, 控制性降压, 硝酸甘油, 胸腔引流量
Objective

To observe the effect of nitroglycerin-controlled hypotension on thoracic drainage and chest drainage time after esophageal cancer radical operation.

Methods

The patients who underwent radical surgery for left thoracic esophageal cancer from March 2015 to April 2017 were randomly divided into the experimental group and the control group. In the experimental group (n = 64), controlled hypotensive blood pressure was controlled by a pump of 0.01% nitroglycerin solution within 48 hours after operation. The blood pressure was controlled strictly in the range of 90-100 mmHg / 60-70 mmHg. In the control group (n = 64), no hypotensive nitroglycerin was administered within 48 hours after operation, and the blood pressure fluctuated between 110-148 mmHg / 70-102 mmHg. Preoperative clinical data of two groups were compared, as well as the amount of thoracic drainage and the total amount of thoracic drainage on the 1st, 3rd, 5th, 7th and 9th days after operation, and the time of postoperative drainage of the thoracic drainage tube.

Results

There were no significant differences in the age, gender, lesion, pathological type and TNM staging of the two groups before operation (P>0.05). Postoperative application of nitroglycerin-controlled hypotension can significantly reduce the removal time of thoracic drainage tube [(8.7±1.1)d vs (10.6±1.3 )d, P<0.05], which can significantly reduce the total amount of postoperative drainage[(939±134)ml vs (1 203±146) ml, P<0.01].

Conclusions

The use of nitroglycerin-controlled hypotension after radical resection in the left thoracic esophageal cancer can effectively reduce the total postoperative thoracic drainage, and can shorten the removal time of drainage tubes and hospital stay time.

Key words: Esophageal cancer, Nitroglycerine, Controlled hypotension, Deliberate hypotension
表1 试验组和对照组临床资料比较[n(%)]
临床资料 试验组(n＝64) 对照组(n＝64) χ2值 P值
性别 ? ? 0.629 0.427
? 男性 44(68.7) 49(76.6) ? ?
? 女性 20(31.3) 15(23.4) ? ?
肿瘤部位 ? ? 1.522 0.467
? 胸中段 33(51.6) 36(56.3) ? ?
? 胸下段 21(32.8) 15(23.4) ? ?
? 贲门 10(15.6) 13(20.3) ? ?
病理类型 ? ? 0.548 0.459
? 鳞癌 44(68.7) 39(60.9) ? ?
? 腺癌 20(31.3) 25(39.1) ? ?
TNM分期 ? ? 0.129 0.719
? Ⅰ～Ⅱ期 25(39.1) 28(43.8) ? ?
? Ⅲ期 39(60.9) 36(56.2) ? ?
表2 试验组和对照组术后胸腔引流量、拔管时间和住院时间比较(±s)
指标 试验组(n＝64) 对照组(n＝64) χ2值 P值
胸腔引流量(ml) ? ? ? ?
? 第1天 289±33 302±36 2.130 0.035
? 第3天 242±38 272±33 4.769 0.01
? 第5天 202±42 254±37 6.003 0.01
? 第7天 184±32 212±37 4.579 0.01
? 第9天 142±22 170±32 5.768 0.01
? 总引流量 939±134 1 203±146 10.657 0.01
带管时间(d) 8.7±1.1 10.6±1.3 8.926 0.01
住院时间(d) 9.5±1.2 11.2±2.4 5.068 0.01
表3 试验组和对照组术后并发症发生率比较[n(%)]
并发症 试验组(n＝64) 对照组(n＝64) P值
肺不张 1(1.6) 3(4.7) 0.612
肺部感染 4(6.3) 1(1.6) 0.362
脓胸 1(1.6) 1(1.6) 0.476
乳糜胸 0(0) 1(1.6) 1.000
心律失常 2(3.1) 3(4.7) 1.000
声音嘶哑 1(1.6) 0(0) 1.000
吻合口瘘 0(0) 1(1.6) 1.000
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