不同胸腔闭式引流管疗效对比分析

Clinical Efficacy of Different Thoracic Closed Drainage Tubes

目的:探讨两种不同胸腔引流管治疗自发性气胸的临床效果及适用人群。方法:选取2015年1月-2017年6月本院收治的自发性气胸患者112例。按照随机数字表法将其分为细管组和粗管组,各56例。两组均行胸腔闭式引流,细管组采用一次性使用中心静脉导管(舒贝康),粗管组采用22F硅胶胸腔引流管。观察两组复张拔管时间、住院时间、伤口愈合时间、3 d肺复张率、管道堵塞率、皮下气肿发生率及需要干预的疼痛发生率;分析3 d肺复张率的影响因素;比较两组不同年龄及是否合并基础肺部疾病患者的拔管时间、3 d肺复张率、堵管率。结果:细管组伤口愈合时间、住院时间均短于粗管组,皮下气肿及需要干预的疼痛发生率均低于粗管组,比较差异均有统计学意义(P<0.05);两组复张拔管时间、管道堵塞率、3 d肺复张率比较,差异均无统计学意义(P>0.05);年龄>60岁、合并基础肺部疾病的细管组拔管时间均长于粗管组,3 d肺复张率均低于粗管组,堵管率均高于粗管组,比较差异均有统计学意义(P<0.05);Logistic回归分析显示,引流管粗细、合并基础肺病是影响3 d肺复张的独立因素(P<0.05)。结论:对于未合并基础肺病患者,采用一次性使用中心静脉导管行胸腔闭式引流治疗自发性气胸,是安全有效的,并发症低,可作为首选,但对于老年(>60岁)并且有合并基础肺病的患者,仍建议采用传统硅胶管行胸腔闭式引流治疗。

Objective：To explore the clinical effect and applicable population of two different thoracic drainage tubes in treatment of spontaneous pneumothorax.Method：A total of 112 patients with spontaneous pneumothorax admitted to our hospital from January 2015 to June 2017 were selected.According to the random number table method,they were divided into thin tube group and coarse tube group,56 cases in each group.They were all closed thoracic drainage,the thin tube group was treated with disposable central venous catheter（Shu Beikang）,and coarse tube group was treated with 22 F silica gel chest drainage tube.The extubation time,hospitalization time,wound healing time,3 d lung recruitment rate,pipe blockage rate,the incidence of subcutaneous emphysema and pain requiring intervention in two groups were observed,the influencing factors of 3 d lung recruitment rate were analyzed,the extubation time,3 d lung recruitment rate and pipe blockage rate between two groups of patients with different age and whether with basic lung disease were compared.Result：The wound healing time and hospitalization time in thin tube group were shorter than those of coarse tube group,the incidence of subcutaneous emphysema and pain requiring intervention were lower than those of coarse tube group,the differences were statistically significant（P〈0.05）.The extubation time,3 d lung recruitment rate,pipe blockage rate in two groups were compared,the differences were not statistically significant（P〉0.05）.The extubation time in thin tube group aged〉 60 years old and with basic lung disease were longer than those of coarse tube group,3 d lung recruitment rate were lower than those of coarse tube group,the pipe blockage rate were higher than those of coarse tube group,the differences were statistically significant（P〈0.05）.Logistic regression analysis showed that thin or coarse of drainage tube,combined basic lung disease were independent factors affecting 3 d lung recruitment（P〈0.05）.Conclusion：For patients with no basic lung disease,the treatment of spontaneous pneumothorax with closed thoracic drainage with disposable central venous catheter is safe,effective and low complications,can be used as the first choice,but for the elderly patients（〉60 years old） with basic pulmonary disease,it is still recommended that the traditional silicone tube should be used for thoracic closed drainage.