Tscheikuna Jamsak, Thomrongpairoj Preecha, Disayabutr Suppareurg
Division of Respiratory Disease and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Jun;94(6):679-85.
Malignant pleural effusion (MPE) is a common clinical problem in patients with advanced cancer and portends a poor prognosis, which means survival of less than six months. In June 1997, the US-FDA approved an indwelling TPC with a one-way drainage valve to be used in the management of MPE. Although popularity of this TPC has increased over the past few years, the experience with this device remains limited in Thai patients. One of the reasons is its high cost.
Assess the efficacy and the safety of customary indwelling TPC by using Jackson drain in the management of patients with symptomatic MPE.
Ten patients with symptomatic MPE were receiving these catheters (18 Fr Silicone catheters with 25 cm fenestrated length) to drain effusion via plastic vacuum bottles (250 ml) every other day or as needed to relieve dyspnea. The patient's dyspnic respiration, quality of life, and comfort during the catheter's application were quantified with a Borg score, the St. George Respiratory Disease Questionnaire (SGRQ), and the comfort's score, respectively. These parameters were recorded at initial (before insertion) and 2-week follow-up visit. Pain after 24 hours of each insertion was quantified by visual pain analogue scale (VPAS). Patients were followed until either death or catheter removal.
The Borg score, SGRQ, and comfort's score showed significant improvement at 2-week visit (p < 0.05). Mean VPAS was 2.44. There was no early (2-week) complication, but the catheters were obstructed in three patients (mean = 60 days) and slipped out in two (day 18, day 50).
This modified Jackson drain was effective in the treatment of MPE as a TPC without early complications.
恶性胸腔积液（MPE）是晚期癌症患者常见的临床问题，预示预后不良，即生存期不足6个月。1997年6月，美国食品药品监督管理局（US-FDA）批准一种带有单向引流阀的留置胸腔穿刺导管（TPC）用于MPE的治疗。尽管在过去几年中这种TPC的使用有所增加，但在泰国患者中使用该装置的经验仍然有限。原因之一是其成本高昂。
评估使用杰克逊引流管进行常规留置TPC治疗有症状MPE患者的疗效和安全性。
10例有症状的MPE患者接受这些导管（18F硅胶导管，开窗长度25cm），通过塑料真空瓶（250ml）每隔一天或根据需要引流胸腔积液以缓解呼吸困难。分别用Borg评分、圣乔治呼吸疾病问卷（SGRQ）和舒适度评分对患者在置管期间的呼吸困难、生活质量和舒适度进行量化。这些参数在初始（置管前）和2周随访时记录。每次置管24小时后的疼痛通过视觉模拟疼痛量表（VPAS）进行量化。对患者进行随访直至死亡或拔除导管。
2周随访时Borg评分、SGRQ和舒适度评分均有显著改善（p<0.05）。平均VPAS为2.44。无早期（2周）并发症，但3例患者导管堵塞（平均60天），2例患者导管滑脱（第18天、第50天）。
这种改良的杰克逊引流管作为TPC治疗MPE有效，且无早期并发症。
