Alex Joseph, Ansari Junaid, Bahalkar Pradeep, Agarwala Sandeep, Rehman Mazhar Ur, Saleh Ahmed, Cowen Michael E
Department of Cardiothoracic Surgery, Castle Hill Hospital, Kingston-Upon-Hull, United Kingdom.
Ann Thorac Surg. 2003 Oct;76(4):1046-9. doi: 10.1016/s0003-4975(03)00884-1.
We compared the immediate postoperative outcome and cost-effectiveness of using a single chest drain in the midposition to the conventional apical and basal drains after lobectomy.
Of the 120 consecutive patients who underwent thoracotomy and lobectomy for lung cancer at our center between January 2001 and December 2002, 60 had the conventional 28 French apical and basal drains (group A), whereas the remaining 60 had a single 28 French chest drain placed in the midposition before closure (group B). The assessed outcomes included length of stay, amount and duration of drainage, subcutaneous emphysema, postremoval hemothorax and pneumothorax, drain reinsertion, patient controlled analgesia duration, maximum pain scores, and analgesic usage.
Both groups matched in terms of age (group A vs group B mean, 65 years old vs 66 years old, respectively; p = not significant [NS]) and gender (M:F, 4:1 for group A vs 4:1 for group B). There was no significant difference in the length of stay (mean, 7.7 days for group A vs 7.8 days for group B; p = NS), amount of drainage (mean, 667 mL for group A vs 804 mL for group B; p = NS), duration of drainage (mean, 4 days for group A vs 4.3 days for group B; p = NS), duration of patient controlled analgesia (mean, 3.7 days for group A vs 4.2 days for group B; p = NS) and analgesic combinations used (nonsteroidal antiinflammatory drugs +/- oral opioids +/- paracetamol) between the two groups. There were no clinically significant postdrain removals of hemothorax or pneumothorax in either group. Group A patients had a significantly higher maximum pain score compared with group B patients (mean, 1.4 vs 1.02, respectively; p = 0.02). Cost savings per patient in group B was more than or equal to 55 US dollars, which added up to a total cost savings of approximately more than or equal to 3,300 US dollars.
A single chest drain in the midposition is just as effective, significantly less painful, and much more cost effective than the conventional use of two drains after lobectomy.
我们比较了肺叶切除术后在中间位置使用单根胸管与传统的尖部和基部胸管的术后即时结果及成本效益。
在2001年1月至2002年12月期间于我们中心连续接受开胸肺叶切除术治疗肺癌的120例患者中，60例采用传统的28F尖部和基部胸管（A组），而其余60例在关闭胸腔前在中间位置放置一根28F胸管（B组）。评估的结果包括住院时间、引流量和引流持续时间、皮下气肿、拔管后血胸和气胸、胸管重新插入、患者自控镇痛持续时间、最大疼痛评分以及镇痛药物使用情况。
两组在年龄（A组与B组平均年龄分别为65岁和66岁；p =无显著性差异[NS]）和性别（男:女，A组为4:1，B组为4:1）方面相匹配。两组在住院时间（平均，A组7.7天，B组7.8天；p = NS）、引流量（平均，A组667 mL，B组804 mL；p = NS）、引流持续时间（平均，A组4天，B组4.3天；p = NS）、患者自控镇痛持续时间（平均，A组3.7天，B组4.2天；p = NS）以及使用的镇痛药物组合（非甾体类抗炎药+/-口服阿片类药物+/-对乙酰氨基酚）方面均无显著差异。两组在拔管后均未出现具有临床意义的血胸或气胸。A组患者的最大疼痛评分显著高于B组患者（平均分别为1.4和1.02；p = 0.02）。B组每位患者节省的成本超过或等于55美元，总计节省成本约超过或等于3300美元。
肺叶切除术后在中间位置使用单根胸管与传统使用两根胸管同样有效，疼痛明显减轻，且成本效益更高。
