新引流模式在肺癌术后引流中的应用研究

Study on the application of 20F silicone tube + 8F abdominal drainage tube for postoperative drainage of lung cancer

目的 探究20F硅胶管+8F腹腔引流管引流在胸腔镜肺癌术后患者中的应用效果。方法 选择本院60例胸腔镜肺癌术后患者,随机数字表法分组。对20例患者应用20F硅胶管+8F腹腔引流管引流(新模式1组),拔管阈值:<400ml/24h;对20例患者应用20F硅胶管+8F腹腔引流管引流(新模式2组),拔管阈值:<100ml/24h;对20例患者应用28F硅胶管引流(旧模式组),拔管阈值:<100ml/24h。比较不同引流管置管方式的引流效果以及新模式置管下不同拔管阈值的效果。结果 新模式患者术后1、2、3天疼痛程度明显低于旧模式,住院时间短于旧模式组,住院费用少于旧模式组,切口愈合情况优于旧模式组,肺部并发症发生率低于旧模式组,差异有统计学意义(P<0.05)。术后1、3天炎性反应指标及应激反应指标水平均低于旧模式患者,差异有统计学意义(P<0.05)。新模式下,<400ml拔管阈值模型AUC为0.652(95%CI:0.552~0.714),与实际情况拟合度较好,拔管后疼痛程度更低(P<0.05)。不同拔管阈值下的再住院率、再胸穿率、发热情况差异无统计学意义(P>0.05)。结论 胸腔镜肺癌术后患者应用20F硅胶管+8F腹腔引流管效果优于28F硅胶管引流。新模式下,提升拔管阈值的安全性较高。

Objective To explore the effect of 20F silicone tube + 8F abdominal drainage tube drainage in patients with lung cancer after thoracoscopic surgery. Methods Sixty patients with lung cancer after thoracoscopic surgery in our hospital were selected and grouped by random number table. 20 patients with 20F silicone tube + 8F abdominal drainage tube drainage(new model 1 group), extubation threshold: <400ml/24h. 20patients with 20F silicone tube + 8F abdominal drainage tube drainage(new model 2 group), extubation threshold: <100ml/24h. 20 patients were treated with 28F silicone tube for drainage(old model group), extubation threshold: <100ml/24h. Compared the drainage effects of different drainage tube placement methods and the effects of different extubation thresholds under the new model of catheter placement. Results The pain level of patients with the new model was significantly lower than that of the old model at 1d, 2d, and 3d after the operation. The hospital stay was shorter than that of the old model group, the hospitalization cost was less than the old model group, the incision healing was better than the old model group, the incidence of pulmonary complications was lower than that of the old model group, and the difference was statistically significant( P<0.05). The levels of inflammatory response indexes and stress response indexes at 1 and 3 days after operation were lower than those of the old model patients, the dif-ference was statistically significant(P<0.05). Under the new model, the AUC of the threshold model for extubation of <400ml was 0.652(95%CI:0.552-0.714), which had a better fit to the actual situation, and the degree of pain after extubation was lower( P<0.05). There was no significant difference in the rehospitalization rate, re-thoracic puncture rate and fever under different extubation thresholds( P>0.05). Conclusions The effect of20F silicone tube + 8F abdominal drainage tube on patients with lung cancer after thoracoscopic surgery is better than 28F silicone tube drainage.Under the new mode, it is safer to raise the extubation threshold.