单孔胸腔镜肺大疱切除后中心静脉导管胸腔引流的可行性研究

Study on the feasibility of thoracic drainage with central venous catheter after uniportal video-assisted thoracoscopic bullectomy

目的基于加速康复外科理念,探讨中心静脉导管代替传统胸引流管在单孔胸腔镜肺大疱切除术中的临床应用的可行性。方法选取2013年6月—2016年11月天津市第一中心医院胸外科收治的194例原发性肺大疱继发气胸患者的临床资料。随机分为中心静脉导管组(CVC组)和28 F聚氯乙烯引流管组(28 F组)各97例。比较2组临床效果、胸腔引流量及相关并发症。结果 CVC组住院时间[(3.4±1.1)d vs.(5.9±1.7)d]、术后首次下地活动时间[(4.7±0.7)h vs.(11.5±2.5)h]、带管时间[(34.9±5.4)h vs.(72.3±9.8)h]较28 F组时间短,疼痛评分(3.1±1.4 vs. 7.0±2.5)、引流管口愈合不良发生率(100%vs. 93.8%)较28 F组低(均P<0.05);2组肺感染(1.0%vs.3.1%)、皮下气肿(4.1%vs.2.1%)、持续漏气(1.0%vs. 3.1%)等并发症发生率差异无统计学意义(均P>0.05)。结论中心静脉导管在单孔胸腔镜肺大疱切除术中的效果优于传统胸腔引流管,值得临床推广。

Objective To investigate the validity, security, feasibility and superiority of the clinical application of central venous catheter instead of traditional thoracic drainage tube in uniportal video-assisted thoracoscopic surgery （UVATS） based on the concept of enhanced recovery after surgery （ERAS）. Methods The clinical data of 194 patients who underwent spontaneous pneumothorax in the Tianjin First Central Hospital from June 2013 to November 2016 were included in this study. Patients were divided into central venous catheter group （CVC group） and 28 F polyvinylchlorid chest tube group （28 F group）, 97 cases in each group. Clinical effects, chest drainage volume and related complications were compared between the two groups. Results The hospital stay [（3.4±1.1） d vs. （5.9±1.7） d], leave-bed time after operation [（4.7±0.7） h vs. （11.5±2.5） h] and remove drainage tube time [（34.9±5.4） h vs. （72.3±9.8） h] were significantly less in CVC group than those of 28 F group （P 〈 0.05）. The pain score （3.1±1.4 vs. 7.0±2.5） and incidence of poor wound healing of drainage （100% vs. 93.8%） were also less in CVC group than those of 28 F group （P 〈 0.05）. There were no significant differences in the complication of lung infection （1.0% vs. 3.1%）, subcutaneous emphysema （4.1% vs. 2.1%） and persistent leakage （1.0% vs. 3.1%） between the two groups. Conclusion The application of the central venous catheter technology in uniportal video- assisted thoracoscopic bullectomy is superior to the traditional thoracic drainage, and which is worthy of clinical promotion.