Davis J W, Mackersie R C, Hoyt D B, Garcia J
Department of Surgery, University of California, San Francisco.
J Am Coll Surg. 1994 Nov;179(5):553-7.
The optimal method for removal of chest tubes has not been determined and opinion remains divided. The purpose of this study was to determine the difference between two algorithms for the removal of chest tubes: one with continuous negative intrathoracic pressure (suction group) and the other with a trial of water seal (water-seal group).
This study was a prospective randomized trial of 80 trauma patients requiring tube thoracostomies.
Both methods of chest tube removal had similar incidences of recurrent pneumothorax (2.5 percent). The suction group had a shorter total chest tube time (72.2 hours versus 92.5 hours, p = 0.013) and shorter time required to remove the chest tube following air leak resolution (25.2 hours versus 35.6 hours, p = 0.034). Additionally, there were more patients requiring prolonged (greater than 36 hours) removal times in the water-seal group (p = 0.009).
Both suction and water-seal methods for chest tube removal are effective and have similar incidences of recurrent pneumothorax. The use of the suction algorithm significantly decreased both chest tube duration and the time taken for chest tube removal. In patients hospitalized for isolated pneumo- or hemothorax, the use of the suction algorithm potentially could lead to shorter length of stay.
胸管拔除的最佳方法尚未确定，观点仍存在分歧。本研究的目的是确定两种胸管拔除算法之间的差异：一种是持续胸腔内负压（吸引组），另一种是试行水封（水封组）。
本研究是一项对80例需要进行胸腔闭式引流术的创伤患者的前瞻性随机试验。
两种胸管拔除方法的复发性气胸发生率相似（2.5%）。吸引组的总胸管留置时间较短（72.2小时对92.5小时，p = 0.013），漏气解决后拔除胸管所需要的时间也较短（25.2小时对35.6小时，p = 0.034）。此外，水封组中需要延长（超过36小时）拔除时间的患者更多（p = 0.009）。
胸管拔除的吸引法和水封法均有效，复发性气胸发生率相似。使用吸引算法可显著缩短胸管留置时间和拔除胸管所花费的时间。对于因单纯气胸或血胸住院的患者，使用吸引算法可能会缩短住院时间。
