胸腔闭式引流术中引流管径大小与胸外伤患者预后的关系

Relationship between drainage diameter and prognosis of patients with thoracic trauma during closed thoracic drainage

目的探究胸腔闭式引流术(CTD)中所用引流管径大小与胸外伤患者预后的关系。方法本研究为回顾性队列研究, 选择2017年4月—2021年6月因胸外伤至海军第971医院就诊并接受CTD的146例患者为研究对象。根据预后情况, 分为预后良好组(n=96)和预后不良组(n=50), 对比分析两组患者的手术临床疗效、一般资料以及术后并发症发生情况。多因素Logistic回归分析影响预后不良的危险因素, 建立列线图预测模型, 并进行模型评价。通过Pearson相关性分析引流管径大小与胸外伤患者预后的关系。正态分布的计量资料采用均数±标准差(x^(-)±s)表示, 组间比较采用独立样本t检验;计数资料组间比较采用χ^(2)检验。结果 CTD临床疗效较好, 总有效率为87.67%;且术后3周, 患者预后较好, 预后良好率为65.75%。Logistic分析结果显示, 年龄60岁(OR=1.501, 95%CI:1.105~2.177)、引流口辅料2~3 d更换(OR=2.543, 95%CI:1.729~3.168)、引流瓶高于胸腔(OR=1.692, 95%CI:1.314~2.482)、伤口愈合时间长(OR=1.971, 95%CI:1.479~2.720)、频繁咳嗽(OR=2.259, 95%CI:1.564~2.924)、引流管直径16 F(OR=3.087, 95%CI:2.074~3.793)均为预后不良的独立危险因素(P<0.05)。引流管径大小与住院时间以及伤口愈合时间、疼痛VAS均呈正相关(P<0.05), 与Barthel指数呈负相关(P<0.05)。结论引流管直径16 F为患者预后不良的独立危险因素之一。引流管径越小, 患者术后住院时间越短, 伤口愈合更快, 疼痛更轻, 生活活动能力更强。

Objective To explore the relationship between the diameter of drainage used in closed thoracic drainage(CTD)and the prognosis of patients with thoracic trauma.MethodsThis study was a retrospective cohort study,a total of 146 patients who were admitted to the 971st Navy Hospital due to thoracic trauma from April 2017 to June 2021 and received closed thoracic drainage were selected as the research subjects.According to the prognosis,they were divided into a good group(n=96)and a poor group(n=50),and the clinical efficacy,general data and postoperative complications of the two groups were compared and analyzed.Mulivariate Logistic regression was used to analyze the risk factors for poor prognosis,and a nomogram prediction model was established,and the model was evaluated.The relationship between the size of drainage diameter and the prognosis of patients with thoracic trauma was analyzed by Pearson correlation.The normally distributed measurement data was expressed by the(x^(-)±s),and the independent samples t test was used for comparison between groups;The chi-square test was used for comparison of count data between groups.Results The clinical ficacy of CTD was good,with a total effective probability of 87.67%;and 3 weeks after surgery,the patient's prognosis was good,with a good prognosis probability of 65.75%.Logistic analysis showed that age 60 years old(OR=1.501,95%CI:1.105-2.177),excipient replacement time of 2-3 d(0R=2.543,95%CI:1.729-3.168),drainage bottle higher than thoracic cavity(OR=1.692,95%CI:1.314-2.482),long wound healing time(OR=1.971,95%CI:1.479-2.720),frequent cough(OR=2.259,95%CI:1.564-2.924),and drainage tube diameter 16 F(0R=3.087,95%CI:2.074-3.793)were independent risk factors for poor prognosis(P<0.05).The size of drainage diameter was positively correlated with hospitalization and wound healing time,pain VAS score(P<0.05),and negatively correlated with Barthel Index(P<0.05).Conclusion Drainage tube diameter 16 F is one of the independent risk factors for por prognosis of patients.The smaller the drainage diameter,the shorter the postoperative hospital stay,faster wound healing,lighter pain and stronger ability of life and activity.