Anand Rahul J, Whelan James F, Ferrada Paula, Duane Therese M, Malhotra Ajai K, Aboutanos Michel B, Ivatury Rao R
Virginia Commonwealth University, Department of Surgery, Division of Trauma, Critical Care, and Emergency Surgery, Richmond, Virginia, USA.
Am Surg. 2012 Apr;78(4):478-80.
The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.
胸腔闭式引流管拔除后导致气胸发生的因素尚未完全明确。我们推测，由于存在脂肪组织“保护”层，胸壁较厚的患者在胸腔闭式引流管拔除后发生拔管后气胸（PPP）的几率会显著降低。我们对2010年7月至2011年2月期间在我院创伤科接受胸腔闭式引流术的所有患者进行了回顾性研究。分析了患者的年龄、创伤机制和胸部简明损伤量表评分。复查胸部CT以确定胸壁厚度（CW）。厚度测量于腋中线乳头水平，即皮肤与胸膜腔之间的垂直距离。复查胸腔闭式引流管拔除前后即刻的胸部X线报告，以了解PPP的发生情况。数据以平均值±标准差表示。81例患者共置入91根胸腔闭式引流管。排除胸腔闭式引流管拔除前死亡的患者（n = 11）以及未进行胸部CT扫描的患者（n = 13）。29.9%的胸腔闭式引流管拔除后发生了PPP（20/67）。发生PPP时，20%的病例（4/20）需要再次置入胸腔闭式引流管。单因素分析后发现，年龄较小、穿透性创伤机制和胸壁较薄是发生PPP的显著危险因素。两组患者的胸部简明损伤量表评分相似。Logistic回归分析显示，只有胸壁厚度是发生PPP的独立危险因素。
