肺叶切除术后早期拔除胸腔引流管的前瞻性随机对照研究

Early removal of the chest tube after lobectomies： a prospective randomized control study

目的探讨肺叶切除术后早期拔除胸腔引流管的指征以及其安全性。方法将2012年3至9月70例肺叶切除术患者随机分为两组，其中41例于胸腔引流量≤300mL／24h时拔除引流管（早期组），29例于胸腔引流量≤100ml／24h时拔除引流管（常规组）。记录两组术后24、48h胸腔引流液的量和性状，检测术后24h及拔管即刻的胸腔积液常规、生化指标；记录术后胸腔引流管留置时间及术后住院时间，评估术后及早期拔管后胸腔并发症的发生率、再次置管率及胸腔穿刺率。结果两组患者一般资料、术后24h胸腔积液常规和生化指标水平差异无统计学意义。全部70例患者术后24、48h胸腔引流量中位数为300ml（200～400ml，第一、三四分位数，下同）、250ml（200～300m1）（Z=-2．059，P=0．039）。早期组术后24、48h平均胸腔引流量为（296±153）ml、（285±103）ml，与常规组（332±149）ml、（252±109）ml差异无统计学意义（P〉0．05）。早期组术后住院时间中位数为5．0d（4．5～6．0d），短于常规组的6．0d（6．0～8．0d）（Z=-3．882，P=0．000）。早期组拔管时间中位数为术后44h（44～68h），短于常规组的67h（65～90h）（Z=-2．914，P=0．004）。两组术后及拔管后并发症发生率、胸腔积液复发率、再次置管率及胸腔穿刺率差异无统计学意义（P〉0．05）。结论将术后拔除胸腔引流管的指征设定为引流量≤300ml／24h是可行并且安全有效的，有利于患者术后的快速康复。

Objective To evaluate the feasibility and safety of early chest tube removal after lobectomies for lung diseases. Methods A prospective randomized control study was performed with data collected from lobectomies between March 2012 and September 2012. Eligible patients （n = 70 ） were randomized into two groups; early removal group （removal of chest tube when drainage less than 300 ml/24 h, n = 41 ） and traditional management group （removal of chest tube when drainage less than 100 ml/24 h, n =29）. Criteria for early removal were established and met before chest tube removal. The volume and character of drainage, time of extracting drainage tube and postoperative hospital stay were measured. All patients received standard care during hospital admission and a follow-up visit was performed after 7 days of discharge from hospital. Results There were no differences between two groups with respect to age, sex, comorbidities, or pathologic evaluation of resection specimens. The median volume of drainage within 24 h after surgery was 300 ml and within 48 h was 250 ml, there was significantly different between two groups （Z = -2. 059, P = 0. 039）. Patients undergoing early removal management had a shorter Chest tube duration （44 hours vs. 67 hours, Z = -2. 914, P = 0. 004） and a shorter postoperative hospital stay （5.0 days vs. 6. 0 days, Z = - 3. 882, P = 0. 000 ）. Analysis of data showed no statistically significant differences between the rate of pleural effusions developed, thoracentesis and complications, one week after discharge from hospital. Conclusions Compared to the traditional management group （drainage ≤100 ml/24 h）, early removal of chest tube after lobectomy （drainage ≤300 mE/24 h） is feasible and safe. It could result in a shorter hospital stay, and most importantly, reduces morbidity without the added risk of complications.