Mier José M, Molins Laureano, Fibla Juan J
Servicio de Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, Spain.
Cir Esp. 2010 Jun;87(6):385-9. doi: 10.1016/j.ciresp.2010.03.012. Epub 2010 May 8.
Persistent air leaks represent the most common pulmonary complication after elective lung resection. Since there are insufficient data in the literature regarding variability in the withdrawal of postoperative pleural drainages, we have designed a prospective, consecutive and comparative study to evaluate if the use of digital devices (Thopaz and DigiVent) to measure postoperative air leak compared to a Pleur-Evac varies on deciding when to withdraw chest tubes after lung resection.
A prospective, consecutive and comparative trial was conducted in 75 patients who underwent elective pulmonary resection for non small cell lung cancer. This study compared two digitals devices with the current analogue version in 75 patients. The digital and analogue groups had 26, 24, and 25 patients, respectively.
Clinical population data were not statistically different between the groups. The withdrawal of the chest tube was Thopaz, 2.4 days; Digivent, 3.3 days and PleurEvac, 4.5 days. Patients and nurses were subjectively more comfortable with digital devices. Surgeons obtained more objective information with digital devices. The safety mechanism of the Thopaz was also subjectively better, and one patient was discharged home without complications after one week.
The digital and continuous measurement of air leak instead of the currently used static analogue systems reduced the chest tube withdrawal and hospital stay by more accurately and reproducibly measuring air leak. Intrapleural pressure curves from the Digivent may also help predict the optimal chest tube setting for each patient. The Thopaz alarm mechanism is very useful to prevent deficiencies in the mechanism and do not required wall suction.
持续性气胸漏气是择期肺切除术后最常见的肺部并发症。由于文献中关于术后胸腔引流拔除时机变异性的数据不足,我们设计了一项前瞻性、连续性和对比性研究,以评估与使用胸膜腔引流装置(Pleur-Evac)相比,使用数字设备(Thopaz和DigiVent)测量术后气胸漏气情况对肺切除术后胸腔引流管拔除时机的影响。
对75例行择期非小细胞肺癌肺切除术的患者进行了一项前瞻性、连续性和对比性试验。本研究将两种数字设备与现有的模拟设备在75例患者中进行了比较。数字组和模拟组分别有26例、24例和25例患者。
各组间临床人口学数据无统计学差异。胸腔引流管拔除时间分别为:Thopaz组2.4天;Digivent组3.3天;PleurEvac组4.5天。患者和护士主观上对数字设备更满意。外科医生使用数字设备可获得更客观的信息。Thopaz的安全机制在主观上也更好,1例患者在1周后无并发症出院。
与目前使用的静态模拟系统相比,采用数字设备持续测量气胸漏气情况,能更准确、可重复地测量气胸漏气,从而减少胸腔引流管拔除时间和住院时间。Digivent的胸腔内压力曲线也可能有助于预测每位患者的最佳胸腔引流管设置。Thopaz的报警机制对防止机制缺陷非常有用,且不需要墙壁负压吸引。