探讨加速康复外科流程在单孔胸腔镜肺叶切除术围手术期的应用。

回顾2017年1月至2019年6月陕西中医药大学附属医院胸心外科收治的42例肺癌手术患者，围手术期采用单孔胸腔镜联合加速康复外科流程优化处理模式，分析肺癌根治术后疼痛评分、手术时间、术中补液量、胸腔引流量、胸管留置时间、住院平均时间、炎性指标、并发症等。

所有患者采用单孔胸腔镜肺癌根治术，围手术期采用加速康复外科流程优化处理模式。患者手术时间（167.53±53.86）min、术中补液量（696.20±148.49）mL、术后24 h、48 h、72 h晨起疼痛评分分别3.11±0.62、3.27±0.48、2.69±0.81，术后胸腔引流总量（627.38±76.35）mL，拔胸腔引流管时胸腔引流量（141.07±35.22）mL，胸管拔除时间（3.50±1.73）d、术后住院时间（7.16±1.58）d。观察术后炎症指标：术后第1、4、7天C-反应蛋白水平分别为（49.20±17.48）mg/L、（31.66±17.30）mg/L、（13.37±9.42）mg/L，白细胞计数分别为（14.04±2.55）×10⁹/L、（10.17±1.25）×10⁹/L、（7.71±0.83）×10⁹/L，D-二聚体检测分别为（4.03±1.10）mg/L、（2.92±1.54）mg/L、（1.79±1.14）mg/L。术后肺部感染合并肺不张2例、肺漏气合并皮下气肿2例、胸腔积液3例、心律失常1例，并发症总发生率为19.05%（8/42）。出院时复查胸部CT无气胸及明显胸腔积液，无肺部感染。

宣教管理、饮食管理、气道管理、液体管理、麻醉管理、疼痛管理、管道管理、康复管理等加速康复外科流程管理模式，在肺癌围术期优化组合、多模式管理，建立加速康复外科流程与单孔胸腔镜技术相适应、相结合的处理措施，能加速术后快速康复。

To explore the application and analysis of accelerated rehabilitation procedures in the perioperative period of single-port thoracoscopic lobectomy.

A review of 42 patients undergoing lung cancer surgery admitted to the Department of Thoracic and Cardiovascular Surgery in our hospital from January 2017 to June 2019 was performed. Single-port thoracoscopy combined with accelerated rehabilitation surgery was used in the perioperative period to optimize the processing model of the rehabilitation surgery process. The pain score, operation time after radical lung cancer surgery, intraoperative fluid replacement, chest drainage, chest tube indwelling time, average length of hospital stay, inflammatory indicators, and complications were analyzed.

All patients underwent single-port thoracoscopic radical resection of lung cancer, and the perioperative period used accelerated rehabilitation surgery to optimize the treatment process. The operation time of patients was (167.53±53.86) min. The intraoperative fluid supplement was (696.20±148.49) mL. The morning pain scores at 24 h, 48 h and 72 h after surgery were 3.11±0.62, 3.27±0.48, 2.69±0.81, respectively. The total amount of postoperative chest suction was (627.38±76.35) mL, the chest suction volume was (141.07±35.22) mL when the chest guide tube was pulled out, and the chest tube removal time was (3.50±1.73) d. Postoperative hospitalization time was (7.16±1.58) d. On the first 1, 4, and 7 days after surgery, C-reactive protein levels were (49.20±17.48) mg/L, (31.66±17.30) mg/L, and (13.37±9.42) mg/L; white blood cells were (14.04±2.55) ×10⁹/L, (10.17±1.25) ×10⁹/L, and (7.71±0.83) ×10⁹/L; the D-dimer test were (4.03±1.10) mg/L, (2.92±1.54) mg/L, and (1.79±1.14) mg/L. There were 2 cases of pulmonary infection with atelectasis, 2 cases of lung air leakage with subcutaneous emphysema, 3 cases of pleural effusion, 1 case of arrhythmia, and the total incidence of complications was 19.05% (8/42). Upon discharge from the hospital, there was no pneumothorax and obvious pleural effusion on chest CT, and no lung infection.

Publicity and education management, diet management, airway management, liquid management, anaesthesia management, pain management, pipe management, rehabilitation management and other accelerated rehabilitation surgical process management modes, which are used in lung cancer optimal combination and multi-mode management during the perioperative period, and the establishment of treatment measures that accelerate the rehabilitation of surgical procedures and single-port thoracoscopy technology can accelerate the rapid postoperative recovery.