AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France.
Acta Anaesthesiol Scand. 2012 Apr;56(4):507-12. doi: 10.1111/j.1399-6576.2011.02602.x. Epub 2011 Dec 23.
Little is known about the efficacy of management of iatrogenic pneumothoraces with small-bore chest tubes. The aim of this study was to assess the outcome of iatrogenic pneumothoraces requiring drainage managed with a small-bore chest tube and to compare the results to spontaneous pneumothoraces treated in the same unit with the same device. The primary outcome was requirement of video-assisted thoracoscopic surgery for drainage failure; secondary outcomes were length of drainage and number of inserted chest tubes.
Patients with pneumothorax admitted between 1997 and 2007 were retrospectively identified. Traumatic pneumothoraces and those occurring under mechanical ventilation were excluded. All pneumothoraces were drained using the same small-bore chest tube (8 French) according to our local protocol.
Five hundred sixty-one pneumothoraces were analysed, 431 (76.8%) were spontaneous pneumothoraces and 130 (23.2%) were iatrogenic. Iatrogenic pneumothoraces were associated with less requirement of video-assisted thoracoscopic surgery for drainage failure [adjusted odds ratio= 0.24 (0.04, 0.86)]. Length of drainage of iatrogenic pneumothoraces was longer than for primary spontaneous pneumothoraces (3.8 ± 3.1 vs. 2.7 ± 1.8 days, P < 0.001) and shorter than for secondary spontaneous pneumothoraces (4.6 ± 2.3 days, P = 0.004). Number of inserted chest tubes per patient was not significantly different according to pneumothoraces' aetiology.
Small-bore chest tubes are feasible for treatment of iatrogenic pneumothoraces and have a better rate of success and slightly longer drainage duration than when used for spontaneous pneumothoraces.
对于使用小口径胸腔引流管治疗医源性气胸的疗效知之甚少。本研究旨在评估需要引流的医源性气胸采用小口径胸腔引流管治疗的结果，并将结果与同一单位使用相同设备治疗的自发性气胸进行比较。主要结果是引流失败需要行电视辅助胸腔镜手术；次要结果是引流时间和插入胸腔引流管的数量。
回顾性分析 1997 年至 2007 年期间收治的气胸患者。排除创伤性气胸和机械通气时发生的气胸。所有气胸均根据我们的当地方案使用相同的小口径胸腔引流管（8 号）进行引流。
共分析了 561 例气胸，其中 431 例（76.8%）为自发性气胸，130 例（23.2%）为医源性气胸。医源性气胸引流失败需要行电视辅助胸腔镜手术的可能性较低[校正优势比=0.24（0.04，0.86）]。医源性气胸的引流时间长于原发性自发性气胸（3.8±3.1 天 vs. 2.7±1.8 天，P<0.001），短于继发性自发性气胸（4.6±2.3 天，P=0.004）。根据气胸的病因，每个患者插入胸腔引流管的数量没有显著差异。
小口径胸腔引流管可用于治疗医源性气胸，其成功率较高，引流时间略长于治疗自发性气胸。
