Desai Unnati, Joshi Jyotsna M
Department of Pulmonary Medicine, T. N. Medical College, B. Y. L. Nair Hospital, Mumbai, Maharashtra, India.
Lung India. 2018 Sep-Oct;35(5):395-400. doi: 10.4103/lungindia.lungindia_78_18.
Intercostal chest drainage is required for varied lung diseases with the pleural involvement. While the conventional method of intercostal drainage (ICD) insertion with the bulky underwater drain (UWD) was the gold standard for management, it had numerous disadvantages. It was time and again challenged with better ambulatory methods, although the documentation and continued use of the same are rare in practice. We studied the efficacy of ambulatory chest drainage (ACD) with pigtail and urosac against the conventional drainage methods (ICD-UWD) at a tertiary care center.
This prospective, observational study included the patients requiring chest drainage grouping them as per the intervention they underwent, i.e., (1) Pigtail-Urosac (ACD group) and (2) ICD-UWD (Non-ACD group). The clinical data were recorded and analyzed for the difference in the hospital stay, the total duration of drainage, successful outcome, residual disease, and pain in both groups using unpaired t-test and Chi-square test.
Of the 85 patients included in the study; 45 had pigtail-urosac and 40 had ICD-UWD, consisting of 34 pleural effusions and 51 pneumothoraces. The ACD and non-ACD groups were similar in etiology. Of the 85 patients, 50 had complete lung expansion, 18 pleural thickening, 15 loculated residual disease, and two pleurocutaneous fistulae. In the ACD group, the hospital stay was less as compared to the non-ACD group, i.e., 4.06 (4.42) versus 19.68 (31.39) days (P = 0.0008). The duration of chest drainage showed a similar trend, i.e., 19.29 (66.91) versus 52.18 (46.38) days (P = 0.006). Pain (P < 0.0001) recorded was significantly less with better expansion (P < 0.0001), less pleural thickening (P = 0.0067), and residual disease (P = 0.0087) in the ACD group.
The use of pigtail-urosac is a safe, effective, and preferred method for ACD.
多种累及胸膜的肺部疾病需要进行肋间胸腔引流。虽然传统的肋间引流（ICD）插入粗大的水下引流装置（UWD）的方法是治疗的金标准，但它有许多缺点。尽管在实践中对更好的门诊治疗方法的记录和持续使用很少，但它一次又一次地受到挑战。我们在一家三级医疗中心研究了猪尾导管联合尿袋进行门诊胸腔引流（ACD）相对于传统引流方法（ICD-UWD）的疗效。
这项前瞻性观察性研究纳入了需要胸腔引流的患者，根据他们接受的干预措施将其分组，即：（1）猪尾导管-尿袋组（ACD组）和（2）ICD-UWD组（非ACD组）。记录并分析两组患者的临床数据，包括住院时间、总引流时间、治疗成功结果、残留疾病情况以及疼痛程度，采用非配对t检验和卡方检验。
该研究共纳入85例患者；45例采用猪尾导管-尿袋引流，40例采用ICD-UWD引流，其中包括34例胸腔积液和51例气胸。ACD组和非ACD组的病因相似。85例患者中，50例肺完全复张，18例胸膜增厚，15例有包裹性残留疾病，2例有胸膜皮肤瘘。ACD组的住院时间比非ACD组短，分别为4.06（4.42）天和19.68（31.39）天（P = 0.0008）。胸腔引流时间也呈现相似趋势，分别为19.29（66.91）天和52.18（46.38）天（P = 0.006）。ACD组记录的疼痛程度（P < 0.0001）明显较轻，肺复张情况更好（P < 0.0001），胸膜增厚较少（P = 0.0067），残留疾病较少（P = 0.0087）。
猪尾导管联合尿袋用于门诊胸腔引流是一种安全、有效的首选方法。
