Rivera Louis, O'Reilly Eamon B, Sise Michael J, Norton Valerie C, Sise C Beth, Sack Daniel I, Swanson Sophia M, Iman Rahwa B, Paci Gabrielle M, Antevil Jared L
Division of Trauma, Scripps Mercy Hospital, San Diego, California 92103, USA.
J Trauma. 2009 Feb;66(2):393-9. doi: 10.1097/TA.0b013e318173f81e.
Image-guided small catheter tube thoracostomy (SCTT) is not currently used as a first-line procedure in the management of patients with chest trauma. We adopted a practice recommendation to use SCTT as a less invasive alternative in the treatment of chest injuries. We reviewed our trauma registry to evaluate our change in practice and the effectiveness of SCTT.
Retrospective review of all tube thoracostomies (TT) performed in patients with chest injury at a level I trauma center from September 2002 through March 2006. Data collected included age, sex, indications and timing for TT, use of antibiotics, length of stay, complications, and outcomes. Large catheter tube thoracostomy (LCTT) not performed in the operating room or trauma room and all SCTT were deemed nonemergent.
There were 565 TT performed in 359 patients. Emergent TT was performed in 252 (70%) and nonemergent TT in 157 (44%) patients, of which 63 (40%) received LCTT and 107 (68%) received SCTT. Although SCTT was performed later after injury than nonemergent LCTT (5.5 days vs. 2.3 days, p < 0.001), average duration of SCTT was shorter (5.5 days vs. 7 days, p < 0.05). Rates of hemothoraces were similarly low for SCTT versus nonemergent LCTT (6.1% vs. 4.2%, p = NS) and rates of residual/recurrent pneumothoraces were not significantly different (8% vs. 14%, p = NS). The rate of occurrence of fibrothorax, however, was significantly lower for SCTT compared with nonemergent LCTT (0% vs. 4.2%, p < 0.05). In patients receiving a single nonemergent TT, SCTT was performed in 55 (61%) and LCTT in 35 (39%). A comparison of these groups revealed that SCTT was performed in older patients (p < 0.05), and was associated with a lower Injury Severity Score (p < 0.05) and shorter length of stay (p = 0.05). SCTT was increasingly used in younger and more seriously injured patients as our experience grew.
SCTT is effective in managing chest trauma. It is comparable with LCTT in stable trauma patients. This study supports adopting image-guided small catheter techniques in the management of chest trauma in stable patients.
在胸部创伤患者的治疗中，影像引导下小导管胸腔闭式引流术（SCTT）目前未被用作一线治疗方法。我们采用了一项实践建议，将SCTT作为胸部损伤治疗中侵入性较小的替代方法。我们回顾了我们的创伤登记资料，以评估我们的实践变化以及SCTT的有效性。
回顾性分析2002年9月至2006年3月在一级创伤中心对胸部损伤患者进行的所有胸腔闭式引流术（TT）。收集的数据包括年龄、性别、TT的适应证和时机、抗生素的使用、住院时间、并发症及结局。未在手术室或创伤室进行的大导管胸腔闭式引流术（LCTT）以及所有SCTT均被视为非急诊手术。
359例患者共进行了565次TT。252例（70%）患者进行了急诊TT，157例（44%）患者进行了非急诊TT，其中63例（40%）接受了LCTT，107例（68%）接受了SCTT。尽管SCTT在受伤后比非急诊LCTT实施时间晚（5.5天对2.3天，p<0.001），但SCTT的平均持续时间较短（5.5天对7天，p<0.05）。SCTT与非急诊LCTT的血胸发生率相似（6.1%对4.2%，p=无统计学意义），残留/复发性气胸发生率无显著差异（8%对14%，p=无统计学意义）。然而，与非急诊LCTT相比，SCTT的纤维胸发生率显著更低（0%对4.2%，p<0.05）。在接受单次非急诊TT的患者中，55例（61%）进行了SCTT，35例（39%）进行了LCTT。对这些组的比较显示，SCTT在年龄较大的患者中实施（p<0.05），且与较低的损伤严重度评分相关（p<0.05）以及住院时间较短（p=0.05）。随着我们经验的增加，SCTT越来越多地用于年轻且受伤更严重的患者。
SCTT在胸部创伤治疗中有效。在稳定的创伤患者中，它与LCTT相当。本研究支持在稳定患者的胸部创伤治疗中采用影像引导下小导管技术。
