Kim Min Joung, Park Incheol, Park Joon Min, Kim Kyung Hwan, Park Junseok, Shin Dong Wun
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
PLoS One. 2017 Jun 22;12(6):e0178802. doi: 10.1371/journal.pone.0178802. eCollection 2017.
The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults.
Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications.
Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, I2 = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I2 = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I2 = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I2 = 85%).
Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of relevant studies. (Registration of study protocol: PROSPERO, CRD42016037866).
气胸（PTX）初始治疗的理想侵入性管理方法仍存在争议。本系统评价和荟萃分析的目的是研究肋间置管引流及其他各种侵入性方法作为成人PTX所有亚型初始治疗方法有效性的证据。
检索了从建库至2016年5月29日的三个数据库：MEDLINE、EMBASE和Cochrane CENTRAL。纳入评估肋间置管引流作为对照、各种侵入性方法作为成人PTX初始治疗干预措施的随机对照试验。主要结局是每种方法的早期成功率，效应量采用风险比（RR）进行测量。次要结局包括复发率、住院率、住院时间和并发症。
七项研究符合纳入标准。六项研究的干预措施为穿刺抽吸，一项研究为连接单向阀的导管插入术。对早期成功率、复发率、住院率和住院时间进行了荟萃分析。穿刺抽吸在早期成功率方面低于肋间置管引流（RR = 0.82，置信区间[CI] = 0.72至0.95，I² = 0%）。虽然穿刺抽吸和肋间置管引流在复发率方面无显著差异（RR = 0.84，CI = 0.57至1.23，I² = 0%），但穿刺抽吸的住院时间比肋间置管引流短（平均差 = -1.73，CI = -2.33至-1.13，I² = 0%）。穿刺抽吸的住院率低于肋间置管引流，但存在明显异质性（RR = 0.38，CI = 0.19至0.76，I² = 85%）。
穿刺抽吸在早期缓解方面不如肋间置管引流，但住院时间较短。穿刺抽吸和肋间置管引流的复发率无显著差异。由于相关研究数量较少，连接单向阀的导管插入术的疗效尚无定论。（研究方案注册号：PROSPERO，CRD42016037866）
