中心静脉导管在单孔胸腔镜肺叶切除术后快速康复中应用的随机对照研究
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摘要
目的探讨单孔胸腔镜肺叶切除术后中心静脉导管胸腔引流改进方法对患者快速康复的影响。方法前瞻性纳入2016年7月至2018年3月于重庆医科大学附属第一医院胸外科行单孔胸腔镜肺叶切除术的患者共150例。按照随机数字表将患者分为试验组(采用中心静脉导管)及对照组。试验组,男44例、女28例,年龄(47±11)岁,采用26号硅橡胶胸腔引流管及中心静脉导管引流,胸腔引流量<300 ml/d时拔除引流管。试验组患者出院后3 d复查胸部X线片,经中心静脉导管抽液后拔除中心静脉导管。对照组,男40例、女29例,年龄(52±13)岁,术后采用26号硅胶单胸腔引流管引流,胸腔引流量<100 ml/d时拔除引流管。比较两组临床效果。结果两组患者的一般临床资料、术后并发症、术后第1 d视觉模拟评分(VAS)等差异无统计学意义。试验组术后平均VAS疼痛评分、26号胸腔引流管拔除时间、术后住院时间、曲马多使用人次均低于对照组患者(P<0.05)。试验组有7例患者在拔管后出现中量以上胸腔积液,明显多于对照组(P<0.05),其中6例患者经中心静脉导管抽液而治愈。在拔管前经中心静脉导管抽液量平均为74.8 ml。结论单孔胸腔镜肺叶切除术后应用中心静脉导管和26号胸腔引流管引流,有助于缩短引流时间、促进快速康复。
Objective To evaluate the feasibility and safety of improving chest drainage procedure by applying postoperative chest drainage with central venous catheter for uniportal video-assisted thoracoscopic surgery(VATS)lobectomy in fast track recovery. Methods Between July 2016 and March 2018, a total of 150 patients who underwent uniportal VATS lobectomy by the same chief surgeon were recruited. All patients were randomly divided into two groups including a trial group and a control group. In the trial group, there were 44 males and 28 females with an average age of47±11 years. Central venous catheter and 26 F silicone rubber tuber were used and chest tube was removed when drainage volume less than 300 ml/d. Chest X ray was conducted three days after discharge from hospital and the central venous catheter was removed after thoracentesis. In the control group, there were 40 males and 29 females with an average ages of52±13 years, 26 F silicone rubber tuber and chest tube were removed when drainage volume less than 100 ml/d. The clinical effectiveness was compared between the two groups. Results No statistically significant difference was observed between the trial group and the control group in the date of preoperative general information, the occurrence of postoperative complications and the visual analogue score on Day1 after the operation. However, the visual analogue score, intubation time, post-operative length of stay, the frequency of using tramadol were all significantly shorter or lower in the trial group when compared with the control group(P<0.05). Seven patients of the trial group suffered moderate pleural effusion after intubation, which was significantly more than that of the control group(P<0.05). Six patients recovered after thoracentes through central venous catheter. The average amount of pleural effusions before removing the central venous catheter was 74.8 ml. Conclusion The use of central venous catheter and 26 F silicone rubber tuber after uniportal VATS lobectomy is safe and feasible for the early removal of chest tube. It is beneficial to fast track recovery.
Objective To evaluate the feasibility and safety of improving chest drainage procedure by applying postoperative chest drainage with central venous catheter for uniportal video-assisted thoracoscopic surgery(VATS)lobectomy in fast track recovery. Methods Between July 2016 and March 2018, a total of 150 patients who underwent uniportal VATS lobectomy by the same chief surgeon were recruited. All patients were randomly divided into two groups including a trial group and a control group. In the trial group, there were 44 males and 28 females with an average age of47±11 years. Central venous catheter and 26 F silicone rubber tuber were used and chest tube was removed when drainage volume less than 300 ml/d. Chest X ray was conducted three days after discharge from hospital and the central venous catheter was removed after thoracentesis. In the control group, there were 40 males and 29 females with an average ages of52±13 years, 26 F silicone rubber tuber and chest tube were removed when drainage volume less than 100 ml/d. The clinical effectiveness was compared between the two groups. Results No statistically significant difference was observed between the trial group and the control group in the date of preoperative general information, the occurrence of postoperative complications and the visual analogue score on Day1 after the operation. However, the visual analogue score, intubation time, post-operative length of stay, the frequency of using tramadol were all significantly shorter or lower in the trial group when compared with the control group(P<0.05). Seven patients of the trial group suffered moderate pleural effusion after intubation, which was significantly more than that of the control group(P<0.05). Six patients recovered after thoracentes through central venous catheter. The average amount of pleural effusions before removing the central venous catheter was 74.8 ml. Conclusion The use of central venous catheter and 26 F silicone rubber tuber after uniportal VATS lobectomy is safe and feasible for the early removal of chest tube. It is beneficial to fast track recovery.
引文
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2车国卫,刘伦旭,石应康.加速康复外科临床应用现状与思考.中国胸心血管外科临床杂志, 2016, 23(3):211-215.
3Coughlin SM, Emmerton-Coughlin HM, Malthaner R.Management of chest tubes after pulmonary resection:a systematic review and metaanalysis. Can J Surg, 2012, 55(4):264-270.
4Alessandro G, Domenico V, Luca V, et al. Enhanced recovery after surgery and video-assisted thoracic surgery lobectomy:the Italian VATS Group surgical protocol. J Thorac Dis, 2018, 10(Suppl 4):S564-S570.
5Marzia U, Stefano F, MatteoS, et al. Anesthesia and fast-track in video-assisted thoracic surgery(VATS):from evidence to practice.J Thorac Dis, 2018r, 10(Suppl 4):S542-S554.
6车国卫,李为民,刘伦旭,等.快速肺康复需要围手术期流程优化.中国胸心血管外科临床杂志, 2016, 23(3):216-220.
7Gómez-Caro A, Roca MJ, Torres J, et al. Successful use of a singlechest drain postlobectomy instead of two classical drains:a randomized study. Eur J Cardiothorac Surg, 2006, 29(4):562-566.
8Xie HY, Xu K, Tang JX, et al. A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the lastchest drain after video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc ThoracSurg, 2015, 21(2):200-205.
9马丹,杨梅,樊骏,等.胸腔镜肺叶切除术后引流管管径对患者舒适度影响的前瞻性队列研究.中国胸心血管外科临床杂志,2015, 22(10):928-931.
10周洪霞,杨梅,廖虎,等.胸腔镜肺叶切除术后16 F尿管胸腔引流可行性的前瞻性队列研究.中国胸心血管外科临床杂志, 2016,23(4):334-340.
11王新连,俞峥,顾家榕,等.超细胸腔引流管在电视胸腔镜肺叶切除术中的应用效果分析.实用临床医药杂志, 2018, 22(11):106-108.
12王世敏,徐广全.双腔胃管代替传统胸腔引流管在胸腔镜肺叶切除术中的应用.临床肺科杂志, 2017, 22(4):689-692.
13Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011,12(3):514-515.
14刘成武,刘伦旭.单孔胸腔镜:微创肺癌切除的再次升华.中国肺癌杂志, 2014, 17(7):527-530.
15郝志鹏,蔡奕欣,付圣灵,等.单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究.中国肺癌杂志, 2016,19(3):122-128.
16向润,朱江,李强,等.快速康复外科理念下单孔与多孔胸腔镜肺叶切除的病例对照研究.中国胸心血管外科临床杂志, 2018,25(4):284-288.
17Lin Y, Zheng W, Zhu Y, et al. Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage:a retrospective observational study. J Thorac Dis, 2016,8(6):1290-1296.
18袁东平,邹小娟,巫雄辉,等.中心静脉导管闭式引流在治疗胸腔积液中的应用价值探讨.中国实用医药杂志, 2017, 12(22):55-56.
2车国卫,刘伦旭,石应康.加速康复外科临床应用现状与思考.中国胸心血管外科临床杂志, 2016, 23(3):211-215.
3Coughlin SM, Emmerton-Coughlin HM, Malthaner R.Management of chest tubes after pulmonary resection:a systematic review and metaanalysis. Can J Surg, 2012, 55(4):264-270.
4Alessandro G, Domenico V, Luca V, et al. Enhanced recovery after surgery and video-assisted thoracic surgery lobectomy:the Italian VATS Group surgical protocol. J Thorac Dis, 2018, 10(Suppl 4):S564-S570.
5Marzia U, Stefano F, MatteoS, et al. Anesthesia and fast-track in video-assisted thoracic surgery(VATS):from evidence to practice.J Thorac Dis, 2018r, 10(Suppl 4):S542-S554.
6车国卫,李为民,刘伦旭,等.快速肺康复需要围手术期流程优化.中国胸心血管外科临床杂志, 2016, 23(3):216-220.
7Gómez-Caro A, Roca MJ, Torres J, et al. Successful use of a singlechest drain postlobectomy instead of two classical drains:a randomized study. Eur J Cardiothorac Surg, 2006, 29(4):562-566.
8Xie HY, Xu K, Tang JX, et al. A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the lastchest drain after video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc ThoracSurg, 2015, 21(2):200-205.
9马丹,杨梅,樊骏,等.胸腔镜肺叶切除术后引流管管径对患者舒适度影响的前瞻性队列研究.中国胸心血管外科临床杂志,2015, 22(10):928-931.
10周洪霞,杨梅,廖虎,等.胸腔镜肺叶切除术后16 F尿管胸腔引流可行性的前瞻性队列研究.中国胸心血管外科临床杂志, 2016,23(4):334-340.
11王新连,俞峥,顾家榕,等.超细胸腔引流管在电视胸腔镜肺叶切除术中的应用效果分析.实用临床医药杂志, 2018, 22(11):106-108.
12王世敏,徐广全.双腔胃管代替传统胸腔引流管在胸腔镜肺叶切除术中的应用.临床肺科杂志, 2017, 22(4):689-692.
13Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011,12(3):514-515.
14刘成武,刘伦旭.单孔胸腔镜:微创肺癌切除的再次升华.中国肺癌杂志, 2014, 17(7):527-530.
15郝志鹏,蔡奕欣,付圣灵,等.单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究.中国肺癌杂志, 2016,19(3):122-128.
16向润,朱江,李强,等.快速康复外科理念下单孔与多孔胸腔镜肺叶切除的病例对照研究.中国胸心血管外科临床杂志, 2018,25(4):284-288.
17Lin Y, Zheng W, Zhu Y, et al. Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage:a retrospective observational study. J Thorac Dis, 2016,8(6):1290-1296.
18袁东平,邹小娟,巫雄辉,等.中心静脉导管闭式引流在治疗胸腔积液中的应用价值探讨.中国实用医药杂志, 2017, 12(22):55-56.