Roberts J S, Bratton S L, Brogan T V
Department of Anesthesiology, University of Washington School of Medicine, Children's Hospital and Medical Center, Seattle 98105, USA.
Chest. 1998 Oct;114(4):1116-21. doi: 10.1378/chest.114.4.1116.
To describe the efficacy of percutaneous pigtail catheters in evacuating pleural air or fluid in pediatric patients.
A case series of children with percutaneous pigtail catheters placed in the pediatric ICU between January 1996 and August 1997.
Urban pediatric teaching hospital in Seattle, WA.
A retrospective chart review.
Ninety-one children required 133 chest catheters. Most patients were infants with congenital heart disease (80%). One hundred thirteen of the catheters (85%) were placed for pleural effusion, with 20 tubes (15%) placed for pneumothorax. Efficacy of drainage of pleural fluid was significantly greater in serous (96%) and chylous (100%) effusions compared with empyema (0%) or hemothorax (81%). Evacuation of pneumothorax was achieved by a pigtail catheter in 75% of patients. Resolution of pleural air or pneumothorax was significantly greater in patients < 10 kg compared with larger children. Complications due to placement of the pigtail catheters included hemothorax (n=3, 2%), pneumothorax (n=3, 2%), and hepatic perforation (n= 1, 1%). There were also complications arising from the use of the catheters, including failure to drain, dislodgment, kinking, loss of liquid ventilation fluid, empyema, and disconnection in 27 of 133 catheters (20%). Significantly more complications during catheter use occurred in patients <5 kg than in larger children.
Percutaneous pigtail catheters are highly effective in drainage of pleural serous and chylous effusions, somewhat less efficacious in drainage of hemothorax or pneumothorax, and least efficacious in drainage of empyema. Infants and smaller children had higher rates of resolution of pleural air and fluid from placement of a pigtail catheter than larger children. Complications from catheter placement were uncommon (5%) but serious, whereas complications associated with continued use of the catheters were more common (20%) but less grave. Strict attention to anatomic landmarks and close monitoring may reduce the number of complications.
描述经皮猪尾导管在小儿患者胸腔气体或液体引流中的疗效。
1996年1月至1997年8月间在儿科重症监护病房放置经皮猪尾导管的儿童病例系列。
华盛顿州西雅图市的城市儿科教学医院。
回顾性病历审查。
91名儿童需要133根胸导管。大多数患者为患有先天性心脏病的婴儿（80%）。133根导管中有113根（85%）用于胸腔积液引流，20根导管（15%）用于气胸引流。与脓胸（0%）或血胸（81%）相比，浆液性（96%）和乳糜性（100%）胸腔积液的引流效果显著更好。75%的患者通过猪尾导管实现了气胸引流。与较大儿童相比，体重<10 kg的患者胸腔气体或气胸的消退情况显著更好。猪尾导管放置引起的并发症包括血胸（n = 3，2%）、气胸（n = 3，2%）和肝穿孔（n = 1，1%）。导管使用也出现了并发症，包括引流失败、移位、扭结、液体通气液丢失、脓胸以及133根导管中有27根（20%）出现断开。体重<5 kg的患者在导管使用期间出现的并发症明显多于较大儿童。
经皮猪尾导管在胸腔浆液性和乳糜性积液引流中非常有效，在血胸或气胸引流中效果稍差，在脓胸引流中效果最差。与较大儿童相比，婴儿和较小儿童通过放置猪尾导管使胸腔气体和液体消退的比例更高。导管放置引起的并发症不常见（5%）但严重，而与导管持续使用相关的并发症更常见（20%）但不太严重。严格注意解剖标志并密切监测可能会减少并发症的数量。
