传统胸腔引流管与中心静脉导管在胸腔镜肺叶切除术后胸腔引流中应用的随机对照研究

Thoracic drainage with traditional chest tube versus central venous catheter after videoassisted thoracoscopic lobectomy:A randomized controlled study

目的比较传统胸腔引流管和中心静脉导管在胸腔镜肺叶切除术后胸腔引流中的有效性和安全性。方法纳入2018年1月—2019年9月于厦门大学附属第一医院行胸腔镜肺叶切除术和系统性肺门及纵隔淋巴结清扫术的200例肺癌患者。采用计算机随机法将患者随机分为两组,A组患者术后留置28F胸腔引流管;B组患者术后留置12G的中心静脉导管。两组患者上肺叶切除术后留置2根胸腔引流管,中、下肺叶切除术后留置1根胸腔引流管。比较两组患者的引流时间、总引流量、住院时间、疼痛评分等。结果最终纳入151例患者进行分析,其中A组患者73例,男26例、女47例,平均年龄(55.38±9.95)岁;B组78例,男37例、女41例,平均年龄(59.86±10.18)岁。两组患者术后第2 d引流量,长时间漏气、血胸、乳糜胸和再次胸腔引流管置管比例差异无统计学意义(P均>0.05)。两组患者术后第1 d引流量[200.0(120.0,280.0)mL vs.57.5(10.0,157.5)mL,P=0.000]、术后第3 d引流量[155.0(100.0,210.0)mL vs.150.0(80.0,215.0)mL,P=0.023]、胸腔总引流量[890.0(597.5,1530.0)mL vs.512.5(302.5,786.3)mL,P=0.000]、最大疼痛评分[(2.29±0.72)分vs.(2.09±0.51)分,P=0.013]和住院时间[7(7,9)d vs.5(4,7)d,P=0.000]差异有统计学意义。结论胸腔镜肺叶切除术后使用中心静脉导管行胸腔引流与常规胸腔引流管相比,住院时间缩短,术后疼痛减轻。

Objective To evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube.Methods This study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital.The patients were randomly divided into two groups,including a group A(left with 28F chest tubes postoperatively)and a group B(left with 12G central venous catheters postoperatively).Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy.Duration and total volume of drainage,length of hospital stay,maximum visual analogue scale score and so forth were compared between the two groups.Results Finally,151 patients were included for analysis.There were 73 patients in the group A,including 26 males and 47 females,with an average age of 55.38±9.95 years,and 78 patients in the group B,including 37 males and 41 females,with an average age of 59.86±10.18 years.No statistical difference was found between the two groups in drainage volume on postoperative day 2,and proportion of prolonged air leaks,hemothorax,chylothorax or drain reinsertion(all P>0.05).There was a statistical difference in drainage volume on postoperative day 1[200.0(120.0,280.0)mL vs.57.5(10.0,157.5)mL,P=0.000],postoperative day 3[155.0(100.0,210.0)mL vs.150.0(80.0,215.0)mL,P=0.023],total volume of drainage[890.0(597.5,1530.0)mL vs.512.5(302.5,786.3)mL,P=0.000],maximum pain score(2.29±0.72 points vs.2.09±0.51 points,P=0.013)and length of hospital stay[7(7,9)d vs.5(4,7)d,P=0.000].Conclusion Compared with conventional chest tubes,central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.