大口径与小口径肋间导管在自发性气胸治疗中的比较。
Comparison of large- and small-bore intercostal catheters in the management of spontaneous pneumothorax.
作者信息
Vedam H, Barnes D J
机构信息
The Alfred Hospital, Melbourne, Victoria, New South Wales, Australia.
出版信息
Intern Med J. 2003 Nov;33(11):495-9. doi: 10.1046/j.1445-5994.2003.00467.x.
BACKGROUND
Spontaneous pneumothoraces (SP) are a common cause of presentation to emergency departments and subsequent hospitalization. In recent years there has been an increasing trend towards the use of small-bore pleural catheters (PC) rather than conventional large-bore intercostal catheters (ICC) in their initial management.
AIMS
To compare the effectiveness and complication rate of ICC and PC in the treatment of SP.
METHODS
A retrospective chart audit was conducted of 67 cases of SP admitted to the Royal Prince Alfred Hospital, Sydney, Australia, between 1 July 1997 and 30 June 2000. Demographic data were recorded, including: (i) patient age, (ii) smoking status, (iii) pneumothorax size, (iv) pneumothorax type and (v) aetiology. Outcome data relating to length of hospital stay (LOS) and treatment failure rates and complications of treatment devices were also recorded.
RESULTS
Successful pneumothorax resolution was achieved (P = 0.72) in 20 of the 31 (65%) patients initially treated with a ICC, and in 26 of the 36 (72%) patients treated with a PC. The mean LOS in the ICC and PC group was 7 days and 5 days, respectively (P = 0.11). The complication rates in the PC and ICC group were 25% and 10%, respectively (P = 0.13), and the recurrence rates for each group were 17% and 6% (P = 0.20), respectively. However, the combined rate of complications and pneumothorax recurrence within 2 months was 42% in those initially treated with PC, compared with 16% in those treated with ICC (P = 0.04).
CONCLUSIONS
PC were as effective as ICC in treating SP in terms of initial pneumothorax resolution and LOS. There were trends towards higher complication and recurrence rates in those treated with PC, but individually these results did not reach statistical significance. However, the combined rate of complications and pneumo-thorax recurrence was significantly higher in those patients treated with the PC than in those treated with ICC.
背景
自发性气胸（SP）是急诊科就诊及后续住院治疗的常见原因。近年来，在SP的初始治疗中，使用小口径胸腔导管（PC）而非传统大口径肋间导管（ICC）的趋势日益增加。
目的
比较ICC和PC治疗SP的有效性和并发症发生率。
方法
对1997年7月1日至2000年6月30日期间澳大利亚悉尼皇家阿尔弗雷德王子医院收治的67例SP患者进行回顾性病历审查。记录人口统计学数据，包括：（i）患者年龄，（ii）吸烟状况，（iii）气胸大小，（iv）气胸类型和（v）病因。还记录了与住院时间（LOS）、治疗失败率和治疗设备并发症相关的结果数据。
结果
最初接受ICC治疗的31例患者中有20例（65%）气胸成功缓解（P = 0.72），接受PC治疗的36例患者中有26例（72%）气胸成功缓解。ICC组和PC组的平均住院时间分别为7天和5天（P = 0.11）。PC组和ICC组的并发症发生率分别为25%和10%（P = 0.13），每组的复发率分别为17%和6%（P = 0.20）。然而，最初接受PC治疗的患者在2个月内并发症和气胸复发的综合发生率为42%，而接受ICC治疗的患者为16%（P = 0.04）。
结论
就初始气胸缓解和住院时间而言，PC在治疗SP方面与ICC一样有效。接受PC治疗的患者并发症和复发率有升高趋势，但这些结果单独来看未达到统计学意义。然而，接受PC治疗的患者并发症和气胸复发的综合发生率显著高于接受ICC治疗的患者。
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