青少年原发性自发性气胸患者引流管留置时间影响因素分析
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摘要
目的探讨青少年原发性自发性气胸(PSP)患者行闭式引流术后引流时间的影响因素。方法收集2015年9月～2017年8月我院胸外科住院的自发性气胸患者60例,通过引流管留置时间分为A组(≤4d) 39例、B组(>4d) 21例,比较两组患者性别、年龄、吸烟史、体重、身高、BMI、气胸压缩比例、发生部位、气胸发生到置管时间、置管规格、手术时间、麻醉用量、肺大泡严重程度,采用多因素Logistic分析探讨青少年PSP胸腔闭式引流后引流时间的影响因素。结果两组患者在性别、年龄、吸烟史、体重、身高、BMI、发生部位、手术时间、麻醉用量、气胸发生到置管时间无统计学差异(P>0.05)。两组患者置管规格、肺大泡严重程度、压缩比例、发作次数有统计学意义(P<0.05);多因素Logistic分析置管规格、肺大泡严重程度、发作次数是影响闭式引流术后引流时间的危险因素(P<0.05)。结论引流管规格、肺大泡严重程度、发作次数是影响青少年原发性自发性气胸患者闭式引流术后引流时间的危险因素。
Objective To investigate the factors associated with the drainage time of primary spontaneous pneumothorax(PSP) after closed chest drainage in adolescents.Methods Sixty PSP adolescents with closed chest drainage from Department of Thoracic Surgery,the Affiliated Hospital of Weifang Medical University were enrolled during September 2015 to August 2017,including 21 with duration of drainage(≤4 d) and 39 with duration of drainage(>4 d).Comparisons were made between the groups in gender,age,BMI,smoking history,height,weight,pneumothorax site,the time from start to implementation of closed thoracic drainage,pulmonary bullae severity,chest tube size,number of episode and pneumothorax size.Multivariate Logistic analysis was performed to examine the associated factors for the PSP duration of drainage after closed chest drainage.Results Both groups showed no significant differences in sex,age,height,weight,smoking history,BMI,operation time,the amount of anesthetics drug and pneumothrax site,long time from start to implementation of closed thoracic drainage(P>0.05).However,PSP patients(A group) demonstrated lower percentage of mild/moderate pulmonary bullae,less number of episode as well as higher percentage of small pneumothorax size compared with B group(P<0.05).Multivariate Logistic analysis found that chest tube size,pulmonary bullae severity and number of episode were the associated factors for PSP recurrence after closed chest drainage(P<0.05).Conclusion Chest tube size,severe pulmonary bullae and number of episode were found to be the risk factors for PSP duration of drainage after closed chest drainage in adolescents.
Objective To investigate the factors associated with the drainage time of primary spontaneous pneumothorax(PSP) after closed chest drainage in adolescents.Methods Sixty PSP adolescents with closed chest drainage from Department of Thoracic Surgery,the Affiliated Hospital of Weifang Medical University were enrolled during September 2015 to August 2017,including 21 with duration of drainage(≤4 d) and 39 with duration of drainage(>4 d).Comparisons were made between the groups in gender,age,BMI,smoking history,height,weight,pneumothorax site,the time from start to implementation of closed thoracic drainage,pulmonary bullae severity,chest tube size,number of episode and pneumothorax size.Multivariate Logistic analysis was performed to examine the associated factors for the PSP duration of drainage after closed chest drainage.Results Both groups showed no significant differences in sex,age,height,weight,smoking history,BMI,operation time,the amount of anesthetics drug and pneumothrax site,long time from start to implementation of closed thoracic drainage(P>0.05).However,PSP patients(A group) demonstrated lower percentage of mild/moderate pulmonary bullae,less number of episode as well as higher percentage of small pneumothorax size compared with B group(P<0.05).Multivariate Logistic analysis found that chest tube size,pulmonary bullae severity and number of episode were the associated factors for PSP recurrence after closed chest drainage(P<0.05).Conclusion Chest tube size,severe pulmonary bullae and number of episode were found to be the risk factors for PSP duration of drainage after closed chest drainage in adolescents.
引文
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[14] 于克维,李月川,张冬睿.不同排气方式对自发性气胸并发胸膜粘连的影响[J].国际呼吸病,2014,36(12):936～938.
[15] 朱建荣.自发性气胸合并胸腔积液的治疗[J].河北医药,2006,28(11):1047～1048.
[2] Tschopp JM,Bintcliffe O,Astoul P,et al.ERS task force statement:diagnosis and treatment of primary spontaneous pneumothorax[J].Eur Respir,2015,46(2):321～335.
[3] Gupta D,Hansell A,Nichols T,et al.Epidemiology of pneumothorax in England[J].Thorax,2000,55(8):666～671.
[4] Baumann MH,Strange C,Heffner JE,et al.Management of spontaneous pneumothorax:an American college of chest physicians delphi consensus statement[J].Chest,2001,119(2):590～602.
[5] Casali C,Stefani A,Ligabue G,et al.Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax[J].Ann Thorac Surg,2013,95(1):249～255.
[6] Sadikot RT,Greene T,Meadows K,et al.Re-currence of primary spontaneous pneumothorax[J].Thorax,1997,52:805～809.
[7] 乔贵宾,陈刚.自发性气胸处理.广东胸外科行业共识(2016年版)[J].中国胸心血管外科临床杂志,2017,24(1):6～15.
[8] Chen JS,Chan WK,Tsai KT,et al.Simple aspiration and drainage and intrapleural minocycline pleurodesis versus simple aspiration and drainage for the initial treatment of primary spontaneous pneumothorax:an open-label,parallel-group,prospective,randomised,controlled trial[J].Lancet,2013,381(9874):1277～1282.
[9] Voisin F,Sohier L,Rochas Y,et al.Ambulatory management of large spontaneous pneumothorax with pigtail catheters[J].Ann Emerg Med,2014,64(3):222～228.
[10] Andrivet P,Djedaini K,Teboul JL,et al.Spontaneous poeumothorax:comparison of the thoracic drainage vs immediate or delayed needle aspiration[J].Chest,1995,108(2):335～339.
[11] 孙嵇洪,李国庆,黄勇.猪尾导管与普通胸管气胸引流效果与安全性的Meta分析[J].第三军医大学学报,2017,39(4):379～384.
[12] Kesieme EB,Dongo A,Ezemba N,et al.Tube thoracostomy:complications and its management[J].Pulmonary Medicine,2012,2012(793):256 878.
[13] Noppen M.Spontaneous pneumothorax:epidemiology,pathophysiology and cause[J].Eur Respir Rev,2010,19(117):217～219.
[14] 于克维,李月川,张冬睿.不同排气方式对自发性气胸并发胸膜粘连的影响[J].国际呼吸病,2014,36(12):936～938.
[15] 朱建荣.自发性气胸合并胸腔积液的治疗[J].河北医药,2006,28(11):1047～1048.