细管留置治疗自发性气胸的优势

The advantage of small-bore chest tube treatment for spontaneous pneumothorax

目的:探讨细管留置治疗自发性气胸的优势。方法:根据治疗方法不同,将患者进行分组比较:(1)将中等量以上原发性气胸患者,分为细管置入+定时抽气与传统气胸针穿刺抽气两个治疗组,对比两组的治疗有效率、气胸闭合时间;(2)将大量原发性气胸患者,分为细管置入+持续负压吸引和传统胸管+闭式引流术两个治疗组,对比两组的治疗有效率、相关并发症、症状缓解时间、带管时间、住院时间。结果:(1)细管置入+定时抽气的治疗有效率(91.7%)较穿刺抽气组(70.0%)高(P=0.029),其气胸闭合时间[(4.56±0.70)d]与后者[(4.89±0.90)d]近似;(2)细管置入+持续负压吸引的平均住院时间[(5.64±0.62)d]较传统胸管闭式引流[(7.2±0.78)d]短(P<0.01),并发症发生率(2/25)较后者(8/23)少(P=0.022),但其平均症状缓解时间[(40.48±14.31)min]较后者[(20.48±7.4)min]长(P<0.01),两者治疗有效率(84%vs 91.3%)、平均带管时间[(4.88±0.55)d vs(5.21±0.77)d]近似。结论:对于中等量以上的自发性气胸均可采取细管留置,然后根据破口愈合情况,酌情考虑延迟抽气、间断抽气以及持续负压吸引。

Objective：To investigate the advantage of small-bore chest tube treatment for spontaneous pneumothorax（SP）. Methods：According to different medical treatment, two different comparisons were made. Comparison A, stable patients with a moderate SP were divided into needle aspiration group and small-bore chest tube with manual aspiration group, the absorption time and the effectiveness were compared. Comparison B, stable patients with a large SP were divided into small-bore chest tube drainage in negative pressure group and traditional large-bore chest tube drainage group,the effectiveness, complication rate, remission time, drainage duration, and the length of stay were compared. Results：In comparison A, the success rate was 91.7%（33/36） in small-bore chest tube group,little higher than 70.0%（21/30） in needle aspiration group（P〈0.05）, and absorption time was （4.56±0.70） d in small-bore chest tube group, similar to （4.89±0.90） d in needle aspiration group. In comparison B, there was no significant difference between small-bore chest tube group and large-bore chest tube group in success rate（84% vs 91.3%, P〉0.05） and drainage duration[（4.88±0.55） d vs （5.21±0.77） d, P〉0.05]. Small-bore chest tube group has shorter length of stay[（5.64±0.62） d vs （7.2±0.78） d, P〈0.01] and lower complication rate（8% vs 34.7%, P〈0.05）, but longer remission time[（40.48±14.31） min vs （20.48±7.4） min, P〈0.01]. Conclusion：Small-bore chest tube can be used to treat all SP above middle-size, and delayed aspiration, needle aspiration or drainage in negative pressure can been chosen according to onset time and breach condition.