早期拔除胸腔引流管在胸腔镜肺部手术后的应用  

Application of early removal of chest tube after video-assisted thoracoscopic lung surgery

作　　者：喻傲 焦子宸 王涛[1] Yu Ao;Jiao Zichen;Wang Tao(Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,210008

出　　处：《中华腔镜外科杂志（电子版）》2020年第6期347-351,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨胸腔镜肺部手术后早期拔除胸腔引流管的可行性和安全性,探索胸腔引流管的拔除指征。方法选择2019年11月至2020年4月在南京大学医学院附属鼓楼医院行胸腔镜肺部手术,并于术后早期(48 h内)拔除胸腔引流管患者117例作为观察组;另外选择2018年11月至2019年4月在南京大学医学院附属鼓楼医院行胸腔镜肺部手术,但术后非早期拔除胸腔引流管患者114例作为对照组。两组在年龄(P=0.476)、性别(P=0.216)、术式(P=0.715)、是否行纵隔淋巴结清扫或采样(P=0.200)、目标肺叶(P=0.925)、病变性质(P=0.957)方面均差异无统计学意义。回顾性分析两组患者术后临床结果、拔除引流管后并发症及再次行胸腔引流情况。结果观察组和对照组拔管前24 h引流量[(245.7±98.1)ml比(120.8±46.8)ml,P<0.001]、术后引流时间[(43.9±2.6)h比(84.5±10.5)h,P<0.001]、术后住院时间[(2.2±0.4)d比(4.2±1.1)d,P<0.001]、住院费用[(5.3±0.4)万元比(5.6±0.3)万元,P<0.001]、拔管后疼痛视觉模拟评分(visionl analogue scale,VAS)[(4.4±1.2)分比(3.3±1.2)分,P<0.001]、拔管后总体并发症发生率(20.5%比10.5%,P=0.036)差异有统计学意义,观察组拔管前后VAS[(5.9±0.8)分比(4.4±1.2)分,P<0.001]和对照组拔管前后VAS[(6.0±0.9)分比(3.3±1.2)分,P<0.001]差异有统计学意义。观察组和对照组拔管前VAS[(5.9±0.8)分比(6.0±0.9)分,P=0.464]、拔管后气胸(1.7%比0.9%,P>0.999)、胸腔积液(12.8%比6.1%,P=0.084)、皮下气肿(2.6%比1.8%,P>0.999)、发热(3.4%比1.8%,P=0.703)、再次行胸腔引流(2.6%比1.8%,P>0.999)发生率差异无统计学意义。结论虽然术后早期拔除引流管可能会增加拔除引流管后胸腔积液的发生率,但早期拔除引流管可以明显减轻患者术后疼痛,并且不会增加气胸、皮下气肿、发热的发生率,也不会增加再次行胸腔引流的风险。因此,胸腔镜肺部手术后早期拔除胸腔引流管是安全、可行的,有利于�Objective To explore the feasibility and safety of early removal of chest tube after video-assisted thoracoscopic lung surgery and explore the indication of removal of chest tube.Methods 117 patients were selected as the observation group who performed video-assisted thoracoscopic lung surgery in the department of cardiothoracic surgery from Nov.2019 to Apr.2020,in Drum Tower Hospital,affiliated with Nanjing University Medical School,and removed chest tube after operation early(in 48 hours).114 patients with routine removal of chest tube were selected as the control group who performed video-assisted thoracoscopic lung surgery in the same hospital from Nov.2018 to Apr.2019.Age(P=0.476),sex(P=0.216),surgical methods(P=0.715),mediastinal lymph node dissection or sampling(P=0.200),target lobes(P=0.925),pathological nature(P=0.957)were similar between the two groups.This retrospective study analyzed the postoperative clinical results,complications and recurrent pleural drainage after extubation between the two groups.Results There were significant differences in the amount of drainage before extubation in 24 hours[(245.7±98.1)mlvs(120.8±46.8)ml,P<0.001],the time of drainage after operation[(43.9±2.6)hvs(84.5±10.5)h,P<0.001],hospitalization time of postoperative[(2.2±0.4)dvs(4.2±1.1)d,P<0.001],hospitalization cost[(53000±4000)yuanvs(56000±3000)yuan,P<0.001],the VAS score after extubation[(4.4±1.2)vs(3.3±1.2),P<0.001],and incidence of total complications after extubation(20.5%vs 10.5%,P=0.036)between the two groups.The VAS score before and after extubation in the observation group[(5.9±0.8)vs(4.4±1.2),P<0.001]and the VAS score before and after extubation in the control group[(6.0±0.9)vs(3.3±1.2),P<0.001]were statistically significant.The VAS score before extubation[(5.9±0.8)vs(6.0±0.9),P=0.464],the incidence of pneumothorax after extubation(1.7%vs 0.9%,P>0.999),pleural effusion(12.8%vs 6.1%,P=0.084),cutaneous emphysema(2.6%vs 1.8%,P>0.999),fever(3.4%vs 1.8%,P=0.703)and recurrent pleural drainage(2.6%vs

关 键 词：胸腔引流管 胸腔镜手术 肺外科 加速康复外科 

分 类 号：R47[医药卫生—护理学]