Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Eur J Cardiothorac Surg. 2018 Oct 1;54(4):635-643. doi: 10.1093/ejcts/ezy141.
In this systematic review with meta-analysis, we sought to determine the current strength of evidence for or against digital and traditional chest drainage systems following pulmonary surgery with regards to hard clinical end points and cost-effectiveness. PubMed, EMBASE and Web of Science were searched from their inception to 31 July 2017. The weighted mean difference (WMD) and the risk ratio were used for continuous and dichotomous outcomes, respectively, each with 95% confidence intervals (CIs). The heterogeneity and risk of bias were also assessed. A total of 10 randomized controlled trials enrolling 1268 patients were included in this study. Overall, digital chest drainage reduced the duration of chest tube placement (WMD -0.72 days; 95% CI -1.03 to -0.40; P < 0.001), length of hospital stay (WMD -0.97 days; 95% CI -1.46 to -0.48; P < 0.001), air leak duration (WMD -0.95 days; 95% CI -1.51 to 0.39; P < 0.001), and postoperative cost (WMD -443.16 euros; 95% CI -747.60 to -138.73; P = 0.004). However, the effect differences between the 2 groups were not significant for the duration of a prolonged air leak and the percentage of patients discharged home on a device. The stability of these studies was strong. No publication bias was detected. It may be necessary to use a digital chest drainage system for patients who underwent pulmonary surgery to reduce the duration of chest tube placement, length of hospital stay and air leak duration.
在这项系统评价和荟萃分析中，我们旨在确定在涉及硬性临床终点和成本效益的情况下，在肺手术后，数字化和传统的胸部引流系统在当前的证据强度。从其开始到 2017 年 7 月 31 日，我们搜索了 PubMed、EMBASE 和 Web of Science。分别使用加权均数差（WMD）和风险比来表示连续和二分变量的结果，每个结果都有 95%的置信区间（CI）。还评估了异质性和偏倚风险。本研究共纳入 10 项随机对照试验，共纳入 1268 例患者。总体而言，数字化胸部引流减少了胸腔引流管留置时间（WMD -0.72 天；95%CI -1.03 至 -0.40；P < 0.001）、住院时间（WMD -0.97 天；95%CI -1.46 至 -0.48；P < 0.001）、漏气时间（WMD -0.95 天；95%CI -1.51 至 0.39；P < 0.001）和术后成本（WMD -443.16 欧元；95%CI -747.60 至 -138.73；P = 0.004）。然而，两组之间在延长漏气时间和患者出院时设备使用比例方面的效果差异没有统计学意义。这些研究的稳定性很强。未发现发表偏倚。对于接受肺手术的患者，可能有必要使用数字化胸部引流系统，以减少胸腔引流管留置时间、住院时间和漏气时间。
