Russo Rachel M, Zakaluzny Scott A, Neff Lucas P, Grayson J Kevin, Hight Rachel A, Galante Joseph M, Shatz David V
From the Department of Surgery (R.M.R., S.A.Z., L.P.N., R.A.H., J.M.G., D.V.S.), UC Davis Medical Center, Sacramento; and Department of Surgery (S.A.Z., L.P.N., R.A.H.), and Clinical Investigation Facility (J.K.G.), David Grant USAF Medical Center, Travis Air Force Base, California.
J Trauma Acute Care Surg. 2015 Dec;79(6):1038-43; discussion 1043. doi: 10.1097/TA.0000000000000693.
Evacuation of traumatic hemothorax (HTx) is typically accomplished with large-bore (28-40 Fr) chest tubes, often resulting in patient discomfort. Management of HTx with smaller (14 Fr) pigtail catheters has not been widely adopted because of concerns about tube occlusion and blood evacuation rates. We compared pigtail catheters with chest tubes for the drainage of acute HTx in a swine model.
Six Yorkshire cross-bred swine (44-54 kg) were anesthetized, instrumented, and mechanically ventilated. A 32 Fr chest tube was placed in one randomly assigned hemithorax; a 14 Fr pigtail catheter was placed in the other. Each was connected to a chest drainage system at -20 cm H2O suction and clamped. Over 15 minutes, 1,500 mL of arterial blood was withdrawn via femoral artery catheters. Seven hundred fifty milliliters of the withdrawn blood was instilled into each pleural space, and fluid resuscitation with colloid was initiated. The chest drains were then unclamped. Output from each drain was measured every minute for 5 minutes and then every 5 minutes for 40 minutes. The swine were euthanized, and thoracotomies were performed to quantify the volume of blood remaining in each pleural space and to examine the position of each tube.
Blood drainage was more rapid from the chest tube during the first 3 minutes compared with the pigtail catheter (348 ± 109 mL/min vs. 176 ± 53 mL/min), but this difference was not statistically significant (p = 0.19). Thereafter, the rates of drainage between the two tubes were not substantially different. The chest tube drained a higher total percentage of the blood from the chest (87.3% vs. 70.3%), but this difference did not reach statistical significance (p = 0.21).
We found no statistically significant difference in the volume of blood drained by a 14 Fr pigtail catheter compared with a 32 Fr chest tube.
创伤性血胸（HTx）的引流通常使用大口径（28 - 40 Fr）胸管来完成，这常常会给患者带来不适。由于担心导管堵塞和血液引流速度，使用较小（14 Fr）猪尾导管治疗HTx尚未得到广泛应用。我们在猪模型中比较了猪尾导管和胸管对急性HTx的引流效果。
六只约克夏杂交猪（44 - 54千克）接受麻醉、仪器植入并进行机械通气。在随机分配的一侧半胸置入一根32 Fr胸管；在另一侧置入一根14 Fr猪尾导管。每根导管均连接至负压为 -20 cm H₂O的胸腔引流系统并夹紧。在15分钟内，通过股动脉导管抽取1500 mL动脉血。将抽取的750 mL血液注入每个胸腔，然后开始用胶体液进行液体复苏。接着松开胸腔引流管的夹子。在5分钟内每分钟测量一次每个引流管的引流量，之后在40分钟内每5分钟测量一次。对猪实施安乐死后，进行开胸手术以量化每个胸腔内残留的血液量并检查每根导管的位置。
在前3分钟内，胸管的血液引流速度比猪尾导管快（348 ± 109 mL/分钟对176 ± 53 mL/分钟），但这种差异无统计学意义（p = 0.19）。此后，两根导管的引流速度没有显著差异。胸管从胸腔引流的血液总量占比更高（87.3%对70.3%），但这种差异未达到统计学意义（p = 0.21）。
我们发现14 Fr猪尾导管与32 Fr胸管引流的血液量无统计学显著差异。
