Tsai Wen-Kai, Chen Wei, Lee Jen-Chih, Cheng Wei-Erh, Chen Chia-Hung, Hsu Wu-Huei, Shih Chuen-Ming
Department of Internal Medicine, Division of Chest Medicine, China Medical University Beigang Hospital, Yulin 651, Taiwan.
Am J Emerg Med. 2006 Nov;24(7):795-800. doi: 10.1016/j.ajem.2006.04.006.
It is still uncertain if large-bore chest tubes (20F-28F) is superior to pigtail catheter (10F-14F) in terms of the management of secondary spontaneous pneumothoraces (SSP). This study was designed to compare the efficacy and safety associated with placement of large-bore chest tubes vs pigtail catheters in adults experiencing the first episode of SSP. We conducted a retrospective chart review of 91 patients experiencing the first episode of SSP in a university hospital over a 3.5-year period who received treatment by either a large-bore chest tube or a pigtail catheter. Any patient who was younger than 18 years or experiencing mechanical ventilation-related barotraumas or pyopneumothorax was excluded from this study. Various parameters including demographical characteristics, size of pneumothorax, complications, time of pigtail or chest tube extubation, and length of hospital stay were collected and analyzed. Among the enrolled 91 patients, including 76 (83.5%) men with a mean age of 60 +/- 19 years, 69 were initially treated with a pigtail, and 22 patients received conventional chest tubes. Fifty patients (72.5%) undergoing the pigtail drainage and 16 (72.7%) undergoing large-bore chest tube treatment of SSP were successfully treated (P = .88). In addition, there was no significant difference in terms of length of hospital stay, extubation time, recurrence rate, and complication. Pigtail catheters offer a safe and effective alternative for large-bore chest tubes to adult patients experiencing the first episode of SSP, and we strongly suggested that pigtail tube drainage should be considered as the initial treatment of choice.
在继发性自发性气胸（SSP）的治疗中，大口径胸管（20F - 28F）是否优于猪尾导管（10F - 14F）仍不确定。本研究旨在比较大口径胸管与猪尾导管置入术在首次发生SSP的成人患者中的疗效和安全性。我们对一所大学医院3.5年内91例首次发生SSP且接受大口径胸管或猪尾导管治疗的患者进行了回顾性病历审查。任何年龄小于18岁、经历机械通气相关气压伤或脓气胸的患者均被排除在本研究之外。收集并分析了各种参数，包括人口统计学特征、气胸大小、并发症、猪尾导管或胸管拔除时间以及住院时间。在纳入的91例患者中，包括76例（83.5%）男性，平均年龄60±19岁，69例最初接受猪尾导管治疗，22例接受传统胸管治疗。50例（72.5%）接受猪尾导管引流和16例（72.7%）接受大口径胸管治疗的SSP患者成功治愈（P = 0.88）。此外,在住院时间、拔管时间、复发率和并发症方面没有显著差异。对于首次发生SSP的成年患者，猪尾导管为大口径胸管提供了一种安全有效的替代方案，我们强烈建议将猪尾导管引流作为首选的初始治疗方法。
