Yap Kok Hooi, Soon Jia Lin, Ong Boon Hean, Loh Yee Jim
Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
Interact Cardiovasc Thorac Surg. 2017 Nov 1;25(5):822-826. doi: 10.1093/icvts/ivx161.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients undergoing pulmonary resection, is there a safe drainage volume threshold for chest drain removal?' Altogether 1054 papers were found, of which 5 papers represented the best evidence. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Chest drainage threshold, where used, ranged from 250 to 500 ml/day. Both randomized controlled trials showed no significant difference in reintervention rates with a higher chest drainage volume threshold. Four studies that performed analysis on other complications showed no statistical significant difference with a higher chest drainage volume threshold. Four studies evaluating length of hospital stay showed reduced or no difference in the length of stay with a higher chest drainage volume threshold. Two cohort studies reported the mortality rate of 0-0.01% with a higher chest drainage volume threshold. We conclude that early chest drain removal after pulmonary resection, accepting a higher chest drainage volume threshold of 250-500 ml/day is safe, and may result in shorter hospital stay without increasing reintervention, morbidity or mortality.
一篇胸外科最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是“在接受肺切除术的患者中，胸腔引流管拔除时是否存在安全的引流量阈值？”共找到1054篇论文，其中5篇代表最佳证据。现将这些论文的作者、期刊、出版日期和国家、所研究的患者群体、研究类型、相关结局及结果制成表格。所采用的胸腔引流阈值为每天250至500毫升。两项随机对照试验表明，较高的胸腔引流量阈值在再次干预率方面无显著差异。四项对其他并发症进行分析的研究表明，较高的胸腔引流量阈值在统计学上无显著差异。四项评估住院时间的研究表明，较高的胸腔引流量阈值会使住院时间缩短或无差异。两项队列研究报告，较高的胸腔引流量阈值下死亡率为0至0.01%。我们得出结论，肺切除术后早期拔除胸腔引流管，接受250至500毫升/天的较高胸腔引流量阈值是安全的，且可能会缩短住院时间，而不会增加再次干预、发病率或死亡率。
