[1]樊榕榕* 李华艳 陈思思 李鹏伟.数字化胸腔引流系统在胸腔镜肺切除术后应用的临床价值[J].中国微创外科杂志,2021,01(1):13-17.
 Fan Rongrong,Li Huayan,Chen Sisi,et al.Clinical Value of Digital Drainage Device in Patients After Thoracoscopic Lung Resection[J].Chinese Journal of Minimally Invasive Surgery,2021,01(1):13-17.
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数字化胸腔引流系统在胸腔镜肺切除术后应用的临床价值()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年1期
页码:
13-17
栏目:
临床研究
出版日期:
2021-02-26

文章信息/Info

Title:
Clinical Value of Digital Drainage Device in Patients After Thoracoscopic Lung Resection
作者:
樊榕榕* 李华艳 陈思思 李鹏伟
(北京大学人民医院胸外科,北京100044)
Author(s):
Fan Rongrong Li Huayan Chen Sisi et al.
Department of Thoracic Surgery, Peking University People’s Hospital, Beijing 100044, China
关键词:
数字化胸腔引流系统肺切除胸腔镜
Keywords:
Digital drainage deviceLung resectionThoracoscope
文献标志码:
A
摘要:
目的探讨数字化胸腔引流系统在胸腔镜肺切除术后患者中的临床应用效果。方法回顾性分析2018年6月~2019年3月我科210例肺切除手术的临床资料,根据术后采用引流装置的不同分为观察组(术后采用数字化胸腔引流系统)和对照组(术后采用传统胸腔引流装置)。比较2组术后留置胸腔引流管时间、术后住院时间、术后疼痛程度、术后胸腔并发症发生率、住院费用及装置更换引流瓶时间。结果观察组术后中位带管时间2.33(1.79,2.96)d,明显短于对照组2.81(1.89,3.47)d(Z=-2.383,P=0.017);术后中位住院时间3.54(2.71,4.33)d,明显短于对照组3.78(2.88,4.83)d(Z=-2.569,P=0.010)。术后第3天疼痛数字评分中位数静息状态0(0,1)分,活动状态1(0,2)分,均明显小于对照组0(0,1)分和1(1,2)分(Z=-3.056,P=0.002;Z=-2.653,P=0.008)。观察组术后并发症明显少于对照组[5 vs.14, χ2=4.142,P=0.042]。2组住院费用无显著性差异[(5.11±1.23)万元 vs.(5.01±1.40)万元,t=-0.578,P=0.564]。22名护士分别模拟2种装置更换引流瓶,观察组更换引流瓶时间明显短于传统组[(4.0±0.7)min vs. (11.5±1.7)min,t=19.336,P=0000]。结论相对于传统胸腔引流装置,数字化胸腔引流系统可以缩短胸腔镜肺切除术后患者带管时间和住院时间,减轻疼痛,降低并发症发生率,并缩短引流瓶更换操作用时,未显著增加住院费用,能给医、护、患均带来收益,值得进一步推广。
Abstract:
ObjectiveTo evaluate the effects of digital drainage system in patients after thoracoscopic lung resection.MethodsClinical data of 210 patients who underwent thoracoscopic lung resection in our hospital between June 2018 and March 2019 were retrospectively collected. The patients were divided into two groups according to their postoperative drainage device: observation group (digital drainage system) and control group (traditional drainage device). The chest tube drainage time, postoperative hospital stay,postoperative numeric rating scale (NRS) for pain, postoperative morbidity rate, total cost and operating time of replacing the drainage device of the two groups were compared.ResultsThe median duration of chest tube drainage in the digital drainage device group [2.33 (1.79, 2.96) d] was shorter than that in the control group [2.81 (1.89, 3.47) d, Z=-2.383, P=0.017],the median postoperative hospital stay [3.54 (2.71,4.33)d] was shorter than the control group [3.78 d (2.88,4.83) d, Z=-2.569, P=0.010] and NRS for pain in resting [0 (0, 1) point] and activity [1 (0, 2) point] on the 3rd postoperative day significantly decreased in the digital drainage device group comparing with the traditional drainage device group [0 (0, 1) point, Z=-3.056, P=0.002 and 1 (1, 2) point, Z=-2.653, P=0.008]. As for overall postoperative complication rate, the digital drainage device group was lower than the control group (5 vs. 14, χ2=4.142, P=0.042) and no difference was found in the hospital cost [(5.11±1.23) ten thousand yuan vs. (5.01±1.40) ten thousand yuan, t=-0.578, P=0.564] between the two groups. When 22 nurses simulated the operation of replacing the drainage device, the time of replacing the drainage bottle with digital chest drainage system was shorter than that of replacing the drainage bottle with traditional device [(4.0±0.7) min vs. (11.5±1.7) min, t=19336, P=0000].ConclusionsCompared with the traditional device, digital drainage device shortens chest tube duration and postoperative hospital stay, relieves postoperative pain and decreases postoperative complication. This device also shortens the operating time of changing drainage bottle without increasing the total cost. It can bring benefits to doctors, nurses and patients, which is worthy of further promotion.

参考文献/References:

[1]Rice TW, Okereke IC, Blackstone EH. Persistent airleak following pulmonary resection. Chest Surg Clin North Am,2002,12(3):529-539.
[2]韩敬泉,曹守强,董庆,等.胸腔镜肺叶切除术后胸腔闭式引流管早期拔出的可行性.中华胸心血管外科杂志,2015,32(2):103.
[3]Abolhoda A, Liu D, Brooks A, et al. Prolonged air leak following radical upper lobectomy: an analysis of incidence and possible risk factors. Chest,1998,113(6):1507-1510.
[4]Brunelli A, Xiume F, Al Refai M. Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a casematched analysis. Chest,2006,130(4):1150-1156.
[5]Brunelli A, Beretta E, Cassava SD, et al. Consensus definitions to promote an evidencebased approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. Eur J Cardiothorac Surg,2011,40(2):291-297.
[6]Pompili C, Detterbeck F, Papagiannopoulos K, et al. Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems. Ann Thorac Surg,2014,98(2):496-497.
[7]Marjański T, Sternau A, Rzyman W. The implementation of a digital chest drainage system significantly reduces complication rates after lobectomy-a randomized clinical trial. Kardiochir Torakochirurgia Pol,2013,2(2):133-138.
[8]Takamochi K,Nojiri S,Oh S,et al. Comparison of digital and traditional thoracic drainage systems for postoperative chest tube management after pulmonary resection: A prospective randomized trial. J Thorac Cardiovasc Surg,2018,155(4):1834-1840.
[9]金鑫,王若天,钱坤,等.数字化胸腔引流系统在胸腔镜下肺结节楔形切除术中的应用价值.中国微创外科杂志,2018,18(12):1115-1117.
[10]Okereke I, Murthy SC, Alster JM. Characterization and importance of air leak after lobectomy. Ann Thorac Surg,2005,79(4):1167-1173.
[11]Liang S, Ivanovic J, Gilbert S, et al. Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection. J Thorac Cardiovasc Surg,2013,145:948-954.
[12]McGuire AL, Petrcich W, Maziak DE, et al. Digital versus analogue pleural drainage phase 1: prospective evaluation of interobserver reliability in the assessment of pulmonary air leaks. Interact Cardiovasc Thorac Surg,2015,21(4):403-407.
[13]Varela G, Jiménez MF, Novoa NM, et al. Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg,2009,35(1):28-31.
[14]Zhou J, Lyu M, Chen N, et al. Digital chest drainage is better than traditional chest drainage following pulmonary surgery: a metaanalysis. Eur J Cardiothorac Surg,2018,54(4):635-643.
[15]Brunelli A, Monteverde M, Borri A, et al. Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg,2004,77(4):1205-1210.
[16]Yeung C, Gilbert S. Digital pleural drainage technology is here to stay time to realize its potential. J Thorac Dis,2018,10(Suppl 33):S3882-S3883.
[17]Brunelli A, Varela G, Refai M, et a1. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg,2010,90(1):204-209.
[18]Pompili C, Miserocchi G. Air leak after lung resection: Pathophysiology and patients’ implications.J Thorac Dis,2016,8(Suppl 1):S46-S54.
[19]Shiroyama T,Okamoto N,Tamiya MJ, et a1.Effective management of persistent pneumothorax using a Thopaz digital drainage system combined with an endobronchial watanabe spigot.Intern Med J,2016,55(6):663-665.
[20]余艳,蔡少如,张福伟,等.数字化胸腔闭式引流系统在肺癌切除术围术期护理中的应用.重庆医学,2017,46(36):5158-5160.
[21]Wojty ME, Wsikowski J, Wójcik N, et al. Assessment of postoperative pain management and comparison of effectiveness of pain relief treatment involving paravertebral block and thoracic epidural analgesia in patients undergoing posterolateral thoracotomy. J Cardiothorac Surg,2019,14(1):78.
[22]Brunelli A, Salati M, Refai M, et al. Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial. Eur J Cardiothorac Surg,2010,37(1):56-60.
[23]Jablonski S, Brocki M, Wawrzycki M, et al. Efficacy assessment of the drainage with permanent airflow measurement in the treatment of pneumothorax with air leak. Thorac Cardiovasc Surg,2014,62(6):509-515.

备注/Memo

备注/Memo:
*通讯作者,Email:fanrr_97@sina.com
更新日期/Last Update: 2021-04-02