Takeyama Ryo, Yamauchi Yoshikane, Kohmaru Shinya, Morita Shizuka, Takahashi Hikaru, Nishida Tomoki, Saito Yuichi, Sakao Yukinori
Department of Surgery, School of Medicine, Teikyo University, Tokyo 173-8605, Japan.
J Clin Med. 2025 Jun 5;14(11):4003. doi: 10.3390/jcm14114003.
: This study was aimed to identify risk factors for persistent air leak after chest tube placement for secondary spontaneous pneumothorax and to determine the optimal timing of treatment. : We retrospectively analyzed 221 cases of secondary spontaneous pneumothorax in patients aged ≥50 years who were treated with chest tube drainage. Patients were categorized into the observation group or additionally treated group based on whether they received interventional treatment beyond chest tube drainage. Air leak resolution patterns were analyzed using hazard function analysis. Risk factors were evaluated using univariate and multivariate analyses. : Hazard function analysis revealed that the probability of air leak resolution decreased by approximately 50% within the first 5 days after the initiation of chest tube drainage, with only 33% of cases resolving by day 7. Beyond days 7-10, resolution probability stabilized at a minimal level. Multivariate analysis identified previous pneumothorax history (HR: 0.422, = 0.007) and low geriatric nutritional risk index (GNRI) (HR: 2.521, < 0.001) as significant independent risk factors for persistent air leak. Further analysis of early resolution (within 7 days) identified female sex (HR: 0.24, = 0.003), absence of previous pneumothorax (HR: 0.21, = 0.003), and higher GNRI values (HR: 1.04, = 0.008) as positive predictors. : Risk stratification based on pneumothorax history and nutritional status enables the optimization of the timing of intervention for persistent air leak. We recommend considering additional treatment between days 7 and 10 of chest tube drainage, with earlier intervention for high-risk patients. This approach may improve patient outcomes while avoiding unnecessarily prolonged conservative management.
本研究旨在确定继发性自发性气胸胸腔置管后持续性漏气的危险因素，并确定最佳治疗时机。我们回顾性分析了221例年龄≥50岁接受胸腔闭式引流治疗的继发性自发性气胸患者。根据患者是否接受了胸腔闭式引流以外的介入治疗，将其分为观察组或额外治疗组。使用风险函数分析漏气缓解模式。通过单因素和多因素分析评估危险因素。风险函数分析显示，胸腔闭式引流开始后的前5天内，漏气缓解的概率下降了约50%，到第7天只有33%的病例缓解。在第7 - 10天之后，缓解概率稳定在最低水平。多因素分析确定既往气胸病史（HR：0.422，P = 0.007）和低老年营养风险指数（GNRI）（HR：2.521，P < 0.001）是持续性漏气的重要独立危险因素。对早期缓解（7天内）的进一步分析确定女性（HR：0.24，P = 0.003）、无既往气胸（HR：0.21，P = 0.003）和较高的GNRI值（HR：1.04，P = 0.008）为阳性预测因素。基于气胸病史和营养状况的风险分层能够优化持续性漏气的干预时机。我们建议在胸腔闭式引流的第7至10天考虑额外治疗，高危患者应更早干预。这种方法可能改善患者预后，同时避免不必要的长期保守治疗。
