中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

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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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–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管引流,胸腔引流量<300 ml/24 h 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/24 h 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 VAS 评分等差异无统计学意义。试验组术后平均 VAS 疼痛评分、26 号胸引管拔除时间、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 号胸引管胸腔引流管,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 ages of 47±11 years. Central venous catheter and 26F silicone rubber tuber were used and removal of chest tube when drainage volume less than 300 ml/24 h. Chest X ray was conducted three days after discharge from hospital and remove the central venous catheter after thoracentesis. In the control group, there were 40 males and 29 females with an average ages of 52±13 years, 26F silicone rubber tuber and removal of chest tube when drainage volume less than 100 ml/24 h. 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 trmadolwere all significantly shorter or lower in the trial group when compared with the control group (P<0.05). Seven patients of the trial group occurred 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 was74.8 ml. Conclutions 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.

关键词: 中心静脉导管; 胸腔镜肺叶切除术; 快速康复; 胸腔引流

Key words: Central venous catheter; video-assisted thoracoscopic surgery (VATS) lobectomy; fast track recovery; chest drain

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