[1]李华艳李东泽周子涵吴文芳樊榕榕**.改良胸腔引流管理方案在胸腔镜肺切除患者快速康复中的应用[J].中国微创外科杂志,2025,01(4):222-226.
　Li Huayan,Li Dongze,Zhou Zihan,et al.Application of a Modified Chest Drainage Management Protocol in Rapid Recovery of Patients Undergoing Thoracoscopic Pulmonary Resection[J].Chinese Journal of Minimally Invasive Surgery,2025,01(4):222-226.
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改良胸腔引流管理方案在胸腔镜肺切除患者快速康复中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年4期
页码:
222-226
栏目:
临床研究
出版日期:
2025-04-25

文章信息/Info

Title:
Application of a Modified Chest Drainage Management Protocol in Rapid Recovery of Patients Undergoing Thoracoscopic Pulmonary Resection
作者:
李华艳李东泽周子涵吴文芳樊榕榕**
(北京大学人民医院胸外科，北京100044)
Author(s):
Li Huayan;  Li Dongze;  Zhou Zihan;  et al.
Department of Thoracic Surgery, Peking University People’s Hospital, Beijing 100044, China
关键词:
胸腔镜手术; 胸腔引流管理; 加速康复外科
Keywords:
Videoassisted thoracic surgery; Chest drainage management; Enhanced recovery after surgery
文献标志码:
A
摘要:
目的探讨改良胸腔引流管理方案在胸腔镜肺切除患者快速康复中的效果。方法回顾性分析2022年7月~2023年12月我科2个医疗组行肺段、肺叶或复合肺叶切除手术218例的临床资料，其中一个医疗组使用传统引流管理方案(对照组，109例)，另一个医疗组使用改良胸腔引流管理方案(改良组，109例)。对照组腋中线第7肋间留置粗管(20~24F胸腔引流管)至胸顶(引流量<300 ml/24 h，漏气量<20 ml/min后拔除)。改良组腋前线第3~4肋间放置粗管至胸顶(漏气量<20 ml/min后拔除)，腋后线第7~8肋间放置细管(7F胸腔引流管)于膈肌表面(引流量<300 ml/24 h后拔除)。比较2组粗管带管时间、总带管时间、总引流量、术后住院时间和术后并发症，以及术后第1、2天疼痛评分、中重度疼痛例数(疼痛评分≥4分)、镇痛泵药物用量和功能活动评分(functional activity score，FAS)。结果改良组粗管带管时间较短［(2.1±1.6)d vs.(2.7±1.8)d，t=-2.715，P=0.007］，总带管时间较长［(3.3±2.0)d vs.(2.7±1.8)d，t=2.308，P=0.022］，但不增加术后住院时间［(4.2±2.2) d vs. (4.1±2.1)d，t=0.247，P=0.805］。在疼痛控制方面，术后第2天改良组活动时疼痛评分较低［(2.1±1.1)分 vs.(2.6±1.3)分，t=-2.885，P=0.004］，中重度疼痛例数较少(5例vs.14例， χ2=4.670，P=0.031)，镇痛泵药物用量较少［(17.9±16.2)ml vs.(27.4±29.4)ml，t=-2.951，P=0.004］。其他指标2组差异无显著性(P>0.05)。在术后功能活动恢复方面，改良组术后第2天FAS A级(活动不受疼痛限制)的占比较高［61.5% (67/109) vs. 46.8% (51/109)，Z=-2.170，P=0.030］。2组术后并发症及切口如期愈合率差异无显著性(P>0.05)。结论改良胸腔引流管理方案在保证充分引流的同时，减轻疼痛程度，改善活动状态，符合加速康复外科(enhanced recovery after surgery，ERAS)理念。
Abstract:
ObjectiveTo investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.MethodsA retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy, lobectomy, or combined lobectomy surgeries between July 2022 and December 2023 in our department. One medical group utilized the traditional chest drainage management protocol (control group, 109 cases), while the other medical group employed the modified chest drainage management protocol (modified group, 109 cases). The control group had a large chest tube (20-24F) placed at the midaxillary line of the 7th intercostal space leading to the apex of the pleural cavity (removed when drainage volume < 300 ml/24 h and air leak < 20 ml/min). In contrast, the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity (removed when air leak < 20 ml/min), and a small tube (7F) placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface (removed when drainage volume < 300 ml/24 h). Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement, total drainage volume, postoperative hospital stay, and postoperative complications. The pain scores, number of cases with moderate to severe pain (pain score ≥4), analgesic pump drug usage, and functional activity score (FAS) were recorded on the 1st and 2nd day after surgery.ResultsThe duration of large tube placement was shorter in the modified group than in the control group ［(2.1±1.6) d vs. (2.7±1.8) d, t=-2.715, P=0.007］, and the total duration of tube placement was longer in the modified group than in the control group ［(3.3±2.0) d vs. (2.7±1.8) d, t=2.308, P=0.022］, without increasing postoperative hospital stay ［(4.2±2.2) d vs. (4.1±2.1) d, t=0.247, P=0.805］. On the postoperative day 2, the modified group showed lower pain scores during activity than the control group ［(2.1±1.1) points vs. (2.6±1.3) points, t=-2.885, P=0.004］, fewer cases with moderate to severe pain (5 cases vs. 14 cases, χ2=4.670, P=0.031), and less analgesic pump drug usage ［(17.9±16.2) ml vs. (27.4±29.4) ml, t=-2.951, P=0.004］. No significant differences were observed in other indicators between the two groups (P>0.05). Additionally, the proportion of patients with FAS grade A (no activity limitation due to pain) was higher in the modified group than in the control group on the postoperative day 2 ［61.5% (67/109) vs. 46.8% (51/109), Z=-2.170, P=0.030］. There were no significant differences in postoperative complications and incision healing rates between the two groups (P>0.05).ConclusionThe modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status, aligning with the principles of enhanced recovery after surgery (ERAS).

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金(92059203)；北京大学人民医院研究与发展基金(RDN2022-07)**通讯作者，Email：fanrongrong@pkuph.edu.cn
更新日期/Last Update: 2025-06-17