电视辅助胸腔镜肺叶切除术后胸腔引流量与拔管时机的研究

The association between drainage volume and removal of chest tube after video-assisted thoracoscopic lobectomy

目的：观察电视辅助胸腔镜（VATS）肺叶切除术后不同胸腔引流量时拔除胸管对患者恢复的影响，以确定适合于尽早拔管的最佳引流量。方法将VATS肺叶切除术后行胸腔闭式引流的患者按纳入标准在术前随机分成3组，A组24 h引流量〈100 mL，B组24 h引流量100～＜200 mL，C组24 h引流量200～300 mL。达到标准后立即拔除胸腔引流管。按出组标准排除后，最终得到符合研究设计的A组90例，B组87例，C组83例。记录各组间带管时间，肺感染、肺不张、拔管后气胸、拔管后胸腔积液、管口渗液、管口延迟愈合的病例数，以及镇痛药用量、术后住院天数等指标，进行统计学分析。结果 A、B、C组患者的平均带管时间（h）分别为91.76±15.59、84.17±18.33、56.14±12.25，应用吗啡缓释片平均剂量（mg）分别为236.82±67.20、187.36±76.64、139.29±52.74，术后住院天数（d）分别为11.47±1.90、10.68±2.50、10.23±2.14，C组以上各项数据均小于A组和B组，差异有统计学意义（P〈0.05）；3组术后肺不张、术后肺感染、拔管后气胸、拔管后胸腔积液、管口渗液、管口延迟愈合的例数差异无统计学意义（P〉0.05）。结论 VATS肺叶切除术后24 h引流量达到300 mL时拔除胸腔引流管是安全可靠的。

Objective To investigate the association between drainage volume and removal of chest tube after video-as？sisted thoracoscopic surgery（VATS） lobectomy. Methods Patients with VATS were randomly divided into three groups：the drainage volume was less than 100 mL/24 h （group A）, the drainage volume was more than 100 mL/24 h but less than 200 mL/24 h（group B） and the drainage volume was more than 200 mL/24 h but less than 300 mL/24 h （group C）. According to in？clusion criteria and exclusion criteria, finally there were 90 patients in group A, 87 patients in group B and 83 patients in group C. The duration of chest-tube drainage, the occurrence of pulmonary infection, pulmonary atelectasis, pneumothorax, hydrothorax, seepage or delayed union after removal of chest tube, the dosage of analgesic and the length of hospital stay af？ter surgery were recorded. Data were analyzed statistically. Results The average durations of chest-tube drainage were （91.76±15.59）h, （84.17±18.33）h and （56.14±12.25）h, the average morphine consumptions were （236.82±67.20）mg, （187.36± 76.64）mg and （139.29±52.74）mg, and the average lengths of hospital stay after surgery were （11.47±1.90）d, （10.68±2.50）d and （10.23 ± 2.14）d for three groups of patients, respectively. And the indexes in group C were distinctly lower than those in group A and group B （P〈0.05）. There were no significant differences in pulmonary atelectasis, the occurrence of postopera？tive pulmonary infection, pneumothorax, hydrothorax, seepage or delayed union after removal of chest tubes between three groups of patients （P 〉 0.05）. Conclusion It is safe and acceptable that the removal of chest tube after VATS when the drainage volume reaches 300 mL within 24 h.