复杂疑难气胸患者在超声引导下胸腔闭式引流术的治疗效果及对炎症因子、肺功能的影响OA

Objective To investigate the therapeutic effects of ultrasound-guided closed thoracic drainage versus conventional closed thoracic drainage in patients with complex and refractory pneumothorax,and to compare the effects of both approaches on inflammatory factor levels and pulmonary function indices in these patients.Methods A total of 128 patients with complex and refractory spontaneous pneumothorax admitted to Mianyang 404 Hospital between September 2021 and September 2024 were selected as the study subjects.Patients were non-randomly divided into a study group(n=64,receiving ultrasound-guided closed thoracic drainage)and a control group(n=64,receiving conventional closed thoracic drainage).To further balance potential differences between the two groups,propensity score matching(PSM)was adopted to match the baseline data at a 1∶1 ratio.Clinical data of matched patients were analyzed.Repeated measures analysis of variance was used to compare the levels of inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)]and pulmonary function indicators[forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1),forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)]between the two groups.Pearson correlation analysis was performed to examine the correlation between preoperative inflammatory factor indicators and pulmonary function indicators.Logistic regression models were used to analyze the impact of ultrasound guidance on postoperative complications following closed thoracic drainage,with subgroup analyses performed.Results Following PSM,50 patients were matched in each group,with comparable baseline characteristics(P＞0.05).Compared with the control group,the study group had shorter operation time,drainage time,and postoperative hospital stay(P＜0.05),higher drainage volume(P＜0.05),lower total complication rate(P＜0.05),and higher overall treatment efficacy rate(P＜0.05).Repeated measures analysis of variance showed:(1)IL-6 and CRP levels in both groups increased initially then decreased over time,while FVC,FEV1,and FEV1/FVC levels increased over time,with statistically significant time effects(P＜0.05);(2)IL-6 and CRP levels at postoperative day 1,3,and 7 in the study group were significantly lower than in the control group,and FVC and FEV1 at postoperative 1 month and 3 months were significantly higher than in the control group(P＜0.05),with statistically significant group effects for all indicators(P＜0.05);(3)The effects of time on IL-6,CRP,FVC,and FEV1 differed between groups based on whether ultrasound guidance was used during closed thoracic drainage,with statistically significant interaction effects(P＜0.05).Pearson analysis revealed negative correlations between IL-6,CRP and FVC,FEV1,and FEV1/FVC(P＜0.05).Logistic regression analysis showed that after adjusting for covariates,ultrasound guidance during closed thoracic drainage remained an independent protective factor for reducing postoperative complications in patients with complex and refractory pneumothorax(OR=0.196,95％CI:0.047～0.816,P=0.025),with consistent results across subgroups(P for interaction＞0.05).Conclusion Ultrasound-guided closed thoracic drainage demonstrates superior efficacy in treating patients with complex and difficult spontaneous pneumothorax,more effectively regulating inflammatory factor levels,improving pulmonary function,and reducing the risk of postoperative complications.