Mori Ryo, Yamazaki Koji, Shoji Fumihiro, Kouso Hidenori, Ushijima Chie, Miura Naoko, Takenaka Tomoyoshi, Takeo Sadanori
Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan.
PLoS One. 2017 Nov 6;12(11):e0187705. doi: 10.1371/journal.pone.0187705. eCollection 2017.
The sensitivity of postoperative pleural air leakage (PAL) after pulmonary resection is evaluated by a simple subjective grading method in clinical practice. A new electronic digital chest drainage evaluation system (DCS) recently became clinically available. This study was designed to evaluate the clinical application of the DCS in monitoring the airflow volume and managing postoperative PAL.
We prospectively enrolled 25 patients who underwent pulmonary resection. Postoperative PAL was evaluated using both conventional PAL grading based on the physician's visual judgment (analog chest drainage evaluation system [ACS]: Level 0 = no leakage to 4 = continuous leakage) and the DCS. The DCS digital measurement was recorded as the flow volume (ml/min), which was taken once daily from postoperative day 1 to the day of chest drainage tube removal.
In total, 45 measurements were performed on 25 patients during the evaluation period. Postoperative PAL was observed in five patients (20.0%) and judged as ACS Level >1. The mean DCS values corresponding to ACS Levels 0, 1, 2, and 3 were 2.42 (0.0-11.3), 48.6 (35.4-67.9), 95.6 (79.7-111.5), and 405.3 (150.3-715.6), respectively. The Spearman correlation test showed a significant positive correlation between the ACS PAL level and DCS flow volume (R = 0.8477, p < 0.001).
A relationship between the visual PAL level by the ACS and the digital value by the DCS was identified in this study. The numeric volume obtained by the DCS has been successful in information-sharing with all staff. The digital PAL value evaluated by the DCS is appropriate, and the use of the DCS is promising in the treatment of postoperative PAL after pulmonary resection.
在临床实践中，肺切除术后胸膜漏气（PAL）的敏感性通过一种简单的主观分级方法进行评估。一种新型电子数字胸腔引流评估系统（DCS）最近已投入临床使用。本研究旨在评估DCS在监测气流量和管理术后PAL方面的临床应用。
我们前瞻性纳入了25例行肺切除术的患者。术后PAL采用基于医生视觉判断的传统PAL分级（模拟胸腔引流评估系统[ACS]：0级 = 无漏气至4级 = 持续漏气）和DCS进行评估。DCS数字测量记录为流量（毫升/分钟），从术后第1天至胸腔引流管拔除日每天测量一次。
在评估期间，对25例患者共进行了45次测量。5例患者（20.0%）观察到术后PAL，判断为ACS级别>1。与ACS 0级、1级、2级和3级相对应的DCS平均值分别为2.42（0.0 - 11.3）、48.6（35.4 - 67.9）、95.6（79.7 - 111.5）和405.3（150.3 - 715.6）。Spearman相关性检验显示ACS PAL级别与DCS流量之间存在显著正相关（R = 0.8477，p < 0.001）。
本研究确定了ACS的视觉PAL级别与DCS的数字值之间的关系。DCS获得的数值成功实现了与所有工作人员的信息共享。DCS评估的数字PAL值是合适的，DCS在肺切除术后PAL的治疗中具有应用前景。
