单腔中心静脉导管应用于中青年首次单侧自发性气胸患者的疗效分析
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摘要
目的总结分析单腔中心静脉导管应用于中青年首次单侧自发性气胸患者中的疗效及价值。方法回顾性分析2013年1月—2017年6月浙江中医药大学附属第一医院接受住院诊治的首次发生单侧自发性气胸中青年患者的临床资料,共计纳入115例研究对象。根据气胸治疗方法的异同,将研究对象分为3组,即行单腔中心静脉导管接水封瓶行胸腔闭式引流术组(A组)45例,单纯性胸腔留置中心静脉导管抽气组(B组)36例,传统的胸腔闭式引流术组(C组)34例。比较分析3组间疗效及胸膜反应、堵管、脱管、感染、出血、皮下气肿、疼痛、漏气等并发症方面的差异。结果单腔中心静脉导管接水封瓶行胸腔闭式引流术组(A组)、单纯性胸腔留置中心静脉导管抽气组(B组)、传统的胸腔闭式引流术组(C组)治疗有效率分别为97.78%、100.00%、97.06%,3组有效率比较,差异无统计学意义(P>0.05)。A组、B组、C组总并发症发生率分别为6.67%、5.56%、32.35%。A、B组的并发症发生率明显低于C组,差异均有统计学意义(均P<0.05)。结论单腔中心静脉导管在中青年首次单侧自发性气胸患者中具有重要的应用价值,其疗效与传统的胸腔闭式引流术接近,但是并发症发生率明显降低,并且具有创伤小、操作简单、患者容易接受等众多优点,其在临床中的应用价值尚值得进一步总结研究。
Objective To evaluate the efficacy and value of a single-lumen central venous catheter in the treatment of the first unilateral spontaneous pneumothorax in young-and middle-aged patients. Methods The clinical data of 115 young-and middle-aged patients with developed first unilateral spontaneous pneumothorax in our hospital between January,2013 and June,2017 were retrospectively analyzed. The patients were divided into three groups based on the different treatment styles. Group A( n = 45) underwent the placement of a single-lumen central venous catheter connected to a water seal bottle and cured with closed thoracic drainage; Group B( n = 36) received single-lumen central venous catheter to extract gas; and group C( n = 34) underwent traditional thoracic closed-chest drainage. The differences in therapeutic effects and complications including pleural reaction,blockage,lumen loss,infection,bleeding,subcutaneous emphysema,pain,air leakage among the three groups were analyzed. Results The effective rate was 6. 67%,5. 56%,32. 35% in group A,group B and group C,respectively,there was no significant differences( P > 0. 05). The total incidence of complications of groups A,B,and C were 97. 78%,100. 00%,and 97. 06%,respectively. The incidence in groups A and B were significantly lower than that in group C,and the difference was statistically significant( P < 0. 05).Conclusion The single-lumen central venous catheter has important application in young-and middle-aged patients with first unilateral spontaneous pneumothorax. Its curative effect rate is similar to that of traditional thoracic closed-chest drainage,but the total incidence of complications is significantly lower. Besides,it has many advantages such as small wound,simple operation and easy accepted by patients,and its application value in clinic is worth further study.
Objective To evaluate the efficacy and value of a single-lumen central venous catheter in the treatment of the first unilateral spontaneous pneumothorax in young-and middle-aged patients. Methods The clinical data of 115 young-and middle-aged patients with developed first unilateral spontaneous pneumothorax in our hospital between January,2013 and June,2017 were retrospectively analyzed. The patients were divided into three groups based on the different treatment styles. Group A( n = 45) underwent the placement of a single-lumen central venous catheter connected to a water seal bottle and cured with closed thoracic drainage; Group B( n = 36) received single-lumen central venous catheter to extract gas; and group C( n = 34) underwent traditional thoracic closed-chest drainage. The differences in therapeutic effects and complications including pleural reaction,blockage,lumen loss,infection,bleeding,subcutaneous emphysema,pain,air leakage among the three groups were analyzed. Results The effective rate was 6. 67%,5. 56%,32. 35% in group A,group B and group C,respectively,there was no significant differences( P > 0. 05). The total incidence of complications of groups A,B,and C were 97. 78%,100. 00%,and 97. 06%,respectively. The incidence in groups A and B were significantly lower than that in group C,and the difference was statistically significant( P < 0. 05).Conclusion The single-lumen central venous catheter has important application in young-and middle-aged patients with first unilateral spontaneous pneumothorax. Its curative effect rate is similar to that of traditional thoracic closed-chest drainage,but the total incidence of complications is significantly lower. Besides,it has many advantages such as small wound,simple operation and easy accepted by patients,and its application value in clinic is worth further study.
引文
[1]Kim MJ,Park I,Park JM,et al.Systematic review and meta-analysis of initial management of pneumothorax in adults:Intercostal tube drainage versus other invasive methods[J].PLo S One,2017,12(6):e0178802.
[2]Bobbio A,Dechartres A,Bouam S,et al.Epidemiology of spontaneous pneumothorax:gender-related differences[J].Thorax,2015,70(7):653-658.
[3]Tschopp JM,Bintcliffe O,Astoul P,et al.ERS task force statement:diagnosis and treatment of primary spontaneous pneumothorax[J].Eur Respir J,2015,46(2):321-335.
[4]Wojciech R,Marek R,Jacek W,et al.Is it possible to standardize the treatment of primary spontaneous pneumothorax?Part 1:etiology,symptoms,diagnostics,minimally invasive treatment[J].Kardiochir Torakochirurgia Pol,2016,13(4):322-327.
[5]Riber SS,Riber LP,Olesen WH,et al.The influence of chest tube size and position in primary spontaneous pneumothorax[J].J Thorac Dis,2017,9(2):327-332.
[6]Hallifax RJ,Psallidas I,Rahman NM.Chest Drain Size:the Debate Continues[J].Current Pulmonology Reports,2017,6(1):26-29.
[7]Kulvatunyou N,Erickson L,Vijayasekaran A,et al.Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax[J].Br J Surg,2014,101(2):17-22.
[8]Hooper CE,Welham SA,Maskell NA,et al.Pleural procedures and patient safety:a national BTS audit of practice[J].Thorax,2015,70(2):189-191.
[9]Iepsen UW,Ringbak T.Small-bore Chest tubes seem to perform better than larger tubes in treatment of spontaneous pneumothorax[J].Dan Med J,2013,60(6):A4644.
[10]Benson JS,Hart ST,Kadlec AO,et al.Small-bore catheter drainage of pleural injury after percutaneous nephrolithotomy:feasibility and outcome from a single large institution series[J].J Endourol,2013,27(12):1440-1443.
[11]Chen JS,Chan WK,Yang PC.Intrapleural minocycline pleurodesis for the treatment of primary spontaneous pneumothorax[J].Curr Opin Pulm Med,2014,20(4):371-376.
[12]Atsushi S,Takuma Y,Takehiro T.Outpatient drainage for patients with spontaneous pneumothorax over 50 years of age[J].Lung India,2017,34(3):232-235.
[13]Karasaki T,Shintomi S,Nomura Y,et al.Outcomes of outpatient treatment for primary spontaneous pneumothorax using a small-bore portable thoracic drainage device[J].Thorac Cardiovasc Surg,2014,62(6):516-520.
[14]Tsuchiya T,Sano A.Outpatient treatment of pneumothorax with a thoracic vent:Economic benefit[J].Respiration,2015,90(1):33-39.
[15]Sano A,Tsuchiya T,Nagano M.Outpatient drainage therapy with a thoracic vent for traumatic pneumothorax due to bull attack[J].Korean J Thorac Cardiovasc Surg,2014,47(6):563-565.
[16]Yotsumoto T,Sano A,Sato Y.Spontaneous Pneumothorax During Pregnancy Successfully Managed with a Thoracic Vent before Surgical Therapy;Report of a Case[J].Kyobu Geka,2015,68(12):1031-1033.
[2]Bobbio A,Dechartres A,Bouam S,et al.Epidemiology of spontaneous pneumothorax:gender-related differences[J].Thorax,2015,70(7):653-658.
[3]Tschopp JM,Bintcliffe O,Astoul P,et al.ERS task force statement:diagnosis and treatment of primary spontaneous pneumothorax[J].Eur Respir J,2015,46(2):321-335.
[4]Wojciech R,Marek R,Jacek W,et al.Is it possible to standardize the treatment of primary spontaneous pneumothorax?Part 1:etiology,symptoms,diagnostics,minimally invasive treatment[J].Kardiochir Torakochirurgia Pol,2016,13(4):322-327.
[5]Riber SS,Riber LP,Olesen WH,et al.The influence of chest tube size and position in primary spontaneous pneumothorax[J].J Thorac Dis,2017,9(2):327-332.
[6]Hallifax RJ,Psallidas I,Rahman NM.Chest Drain Size:the Debate Continues[J].Current Pulmonology Reports,2017,6(1):26-29.
[7]Kulvatunyou N,Erickson L,Vijayasekaran A,et al.Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax[J].Br J Surg,2014,101(2):17-22.
[8]Hooper CE,Welham SA,Maskell NA,et al.Pleural procedures and patient safety:a national BTS audit of practice[J].Thorax,2015,70(2):189-191.
[9]Iepsen UW,Ringbak T.Small-bore Chest tubes seem to perform better than larger tubes in treatment of spontaneous pneumothorax[J].Dan Med J,2013,60(6):A4644.
[10]Benson JS,Hart ST,Kadlec AO,et al.Small-bore catheter drainage of pleural injury after percutaneous nephrolithotomy:feasibility and outcome from a single large institution series[J].J Endourol,2013,27(12):1440-1443.
[11]Chen JS,Chan WK,Yang PC.Intrapleural minocycline pleurodesis for the treatment of primary spontaneous pneumothorax[J].Curr Opin Pulm Med,2014,20(4):371-376.
[12]Atsushi S,Takuma Y,Takehiro T.Outpatient drainage for patients with spontaneous pneumothorax over 50 years of age[J].Lung India,2017,34(3):232-235.
[13]Karasaki T,Shintomi S,Nomura Y,et al.Outcomes of outpatient treatment for primary spontaneous pneumothorax using a small-bore portable thoracic drainage device[J].Thorac Cardiovasc Surg,2014,62(6):516-520.
[14]Tsuchiya T,Sano A.Outpatient treatment of pneumothorax with a thoracic vent:Economic benefit[J].Respiration,2015,90(1):33-39.
[15]Sano A,Tsuchiya T,Nagano M.Outpatient drainage therapy with a thoracic vent for traumatic pneumothorax due to bull attack[J].Korean J Thorac Cardiovasc Surg,2014,47(6):563-565.
[16]Yotsumoto T,Sano A,Sato Y.Spontaneous Pneumothorax During Pregnancy Successfully Managed with a Thoracic Vent before Surgical Therapy;Report of a Case[J].Kyobu Geka,2015,68(12):1031-1033.