Pacharn Preeyacha, Heller Daniel N D, Kammen Bamidele F, Bryce Thomas J, Reddy Mohan V, Bailey Richard A, Brasch Robert C
Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
Pediatr Radiol. 2002 Feb;32(2):138-42. doi: 10.1007/s00247-001-0591-5. Epub 2001 Nov 24.
Chest radiographs (CXRs) are routinely obtained at many institutions in all pediatric patients following thoracostomy tube removal to search for pneumothorax (PTX). To aid in evaluating the necessity of this practice, this study investigates whether clinical signs and symptoms may be a sensitive predictor of PTX in such patients.
Reports from CXRs obtained following chest tube removal in all pediatric patients (374 patients) who underwent cardiac surgery with chest tube placement over 1 year were reviewed. For cases with reported PTX, the PTX was quantified and chart review was performed to assess whether signs and symptoms of PTX preceded the CXR result.
Fifty-one of 374 children (13.6%) had a radiographically defined PTX within 6 h after thoracostomy tube removal. The PTX was large (>40%) in 2 children, moderate (20-40%) in 5 children, and small (<20%) in 44 children. Symptoms (dyspnea, tachypnea, respiratory distress) or signs (increased oxygen requirement, worsening arterial blood gas and/or hypotension) of respiratory distress were present at the time of the initial CXR in six of seven patients, who later underwent a major clinical intervention, and in one patient who did not. Major clinical interventions were performed in all patients with a large PTX, four of five patients with a moderate PTX, and one patient with a small PTX that later enlarged.
Clinical signs and symptoms identified nearly all patients with significant pneumothoraces. Future prospective investigations may examine reserving chest radiography following chest tube removal for select groups, such as symptomatic patients or those with tenuous cardiovascular status.
在许多机构中，所有小儿患者在拔除胸腔引流管后常规进行胸部X线检查（CXR）以寻找气胸（PTX）。为了有助于评估这种做法的必要性，本研究调查临床体征和症状是否可能是此类患者气胸的敏感预测指标。
回顾了所有在1年多时间里接受了心脏手术并放置胸腔引流管的小儿患者（374例）拔除胸腔引流管后获得的胸部X线检查报告。对于报告有气胸的病例，对气胸进行定量，并进行图表回顾以评估气胸的体征和症状是否先于胸部X线检查结果出现。
374名儿童中有51名（13.6%）在拔除胸腔引流管后6小时内有影像学确诊的气胸。2名儿童的气胸为大量（>40%），5名儿童为中度（20 - 40%），44名儿童为少量（<20%）。在最初胸部X线检查时，七名后来接受重大临床干预的患者中有六名以及一名未接受干预的患者出现了呼吸窘迫的症状（呼吸困难、呼吸急促、呼吸窘迫）或体征（吸氧需求增加、动脉血气恶化和/或低血压）。所有大量气胸患者、五名中度气胸患者中的四名以及一名后来气胸扩大的少量气胸患者均接受了重大临床干预。
临床体征和症状几乎识别出了所有有明显气胸的患者。未来的前瞻性研究可以探讨对特定人群，如出现症状的患者或心血管状况不稳定的患者，在拔除胸腔引流管后保留胸部X线检查。
