The Effect Of Postoperative Drainage And Biochemical Indicators In VATS With Thrombin

Objective:This experiment is aimed to observe the effect of postoperative drainage and biochemical indicators in VATS with thrombin.Methods:We choose the patient in fifth subjects of chest,the fourth hospital,Hebei Medical University during Journey 2013-March 2014 as selected cases who were hospitalized and removed the lobus.Meanwhile they should meet the following conditions:1 Tumor is located in a single lobus,and has no obvious relation with parietal pleura and other lobus.2 The pulmonary function and electrocardiogram of patients are normal before performing an operation.In addition the blood routine,blood coagulation function,liver function and kidney function should also normal.3 Patients don’t show head metastasis and bone metastases by CT and ECT.4 There was no effusion in chest before surgery.5 Patients don’t have the high blood pressure,the coronary heart disease,the heart disease and the other chronic illness,and have no obvious lower extremity varicose veins.6 The surgery should be managed by the same group of doctors.The incision were traditionally thoracoscope surgery incision,which included the thoracoscope holes and two operation holes.Doctors place the closed thoracic drainage tube before completing the surgery.7 The patients and their families should consent the surgery.We separated our studied objects into two parts randomly:the experimental group and control group.To watch the activation of bleeding in the surgery wound,dirty pleura and parietal pleura in further before the chest was closed,such as active bleeding,we should stop the bleeding,and suck the effusion completely.Using the steril gauze clean the chest and spraying the thrombin solution(400IU,in 10 ml Nacl)into the surgery wound,dirty pleura and parietal pleura in experimental group before closing the chest.The control group is sprayed 10 ml Nacl.To observe the drainage and biochemical indicators after surgery.Results:1 The physical condition of control group and experimental group p atients:age(61.35±3.573 y,62.65±3.884y),weight(58.65±4.44 kg,57±3.97kg),hei ght(165.15±4.283 cm,163.85±4.308cm),body surface area(1.725±0.066m2,1.696±0.056m2).There was no statistically significant difference(P> 0.05).The ratio of male to female in control group was 12/8.The ratio of male tofemale in experimental group was 13/7.There was no statistically signif icant difference(P=0.261).There were seven left upper lobe lung cancers,f our left lower lobe of lung cancers,seven right upper lobe of lung cance rs and two right lower lobe of lung cancers in control group.There wer eeight left upper lobe lung cancers,five left lower lobe of lung cancers,s ix right upper lobe of lung cancers and one right lower lobe of lung ca ncers in experimental group.There was no statistically significant differen ce(P=0.333).(Table 1)2 The vital signs of all patients were normal after surgery.The control group and experimental group had no anaphylactic shock such as obvious skin rashes and adverse reactions.There were no infection of incision and poor healing.3 The median days of drawing tube in control group and experimental group were 5.5 days or 4 days,the quartile day was 1 day.The differences of drawing tube in control group and experimental group had statistical significance(P< 0.05).(Table 2)4 The count of red blood cells in control group: the first day(0.181±0.056*1011/L),the second day(0.132±0.053*1011/L),the third day(0.111±0.049*1011/L),The count of red blood cells in experimental group:the first day(0.124±0.066*1011/L),the second day(0.037±0.017*1011/L),the third day(0.007±0.006*1011/L),The count of red blood cells in control group and experimental group is declining.In the same time,the count of red blood cells in control group was more than that in experimental group(P<0.05).In declining trends,the decline of control group was greater than that in experimental group(P<0.05).(Table 3)5 The drainage volume in control group in the first three days after surgery:the first day(404.50±68.09ml),the second day(310.50±53.65ml),the third day(200.50±44.071ml),The drainage volume in experimental group in the first three days after surgery: the first day(349.00±35.67ml),the second day(283.00±34.27ml),the third day(100.00±22.24ml),The drainage volume in control group and experimental group is declining.In the same time,the drainage volume in control group was more than that in experimental group(P<0.05).In declining trends,the decline of control group was greater than that in experimental group(P<0.05).(Table 4)6 The concentrations of CRP in control group in the first three days after surgery:the first day(89.60±19.30mg/L),the second day(127.60±22.16mg/L),the third day(117.7±8.64mg/L).The concentrations of CRP in exper imental group in the first three days after surgery:the first day(105.10±16.25mg/L),the second day(144.55±25.73mg/L),the third day(107.05±9.69 m g/L),In the first and second day,the concentrations of CRP in experiment al group was more than that in control group(P<0.05).In the third day,th e difference between experimental group and control group had no statis tical significance(P>0.05).(Table 5)7 The concentrations of PLG in control group in the first three days after surgery:the first day(42.16±5.44ng/ml),the second day(51.10±6.02ng/ml),the third day(34.06±7.36ng/ml),The concentrations of PLG in experimental group in the first three days after surgery:the first day(47.00±5.01ng/ml),the second day(60.40±3.12ng/ml),the third day(38.77±3.40ng/ml),In the same time,the concentrations of PLG in control group was less than that in experimental group,the difference had statistical significance(P<0.05).(Table 6)8 The concentrations of D-D in control group in the first three days after surgery:the first day(1.44±0.29mg/L),the second day(0.86±0.23mg/L),the third day(0.77±0.15mg/L),The concentrations of D-D in experimental group in the first three days after surgery:the first day(1.55±0.22mg/L),the second day(0.94±0.12mg/L),the third day(0.83±0.20mg/L),In the same time and different times,the difference of concentrations of D-D between experimental group and control group had no statistical significance(P>0.05).9 The concentrations of FIB in control group in the first three days after surgery:the first day(3.93±0.55g/L),the second day(4.68±0.51g/L),the third day(5.12±0.79g/L),The concentrations of FIB in experimental group in the first three days after surgery:the first day(4.16±0.43g/L),the second day(4.89±0.4g/L),the third day(5.43±0.49g/L).In the same time and different times,the difference of concentrations of FIB between experimental group and control group had no statistical significance(P>0.05).Conclusion:1 The thrombin sprays in VATS can reduce the drainage volume before closed the chest and shorten the time of drawing tube.2 The thrombin reduces the count of red blood cells in drainage volume.3 The thrombin can increase the concentrations of PLG.So,it curbs the solution of fiber,advances the adhesions of chest and reduces the drainage volume.4 It needs the further research to discover whether the thrombin could cause the pneumonia,infection of incision and poor healing.