Cerfolio R J, Tummala R P, Holman W L, Zorn G L, Kirklin J K, McGiffin D C, Naftel D C, Pacifico A D
Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, 35294-0006, USA.
Ann Thorac Surg. 1998 Nov;66(5):1726-31. doi: 10.1016/s0003-4975(98)00958-8.
Air leaks (ALs) are a common complication after pulmonary resection, yet there is no consensus on their management.
An algorithm for the management of chest tubes (CT) and ALs was applied prospectively to 101 consecutive patients who underwent elective pulmonary resection. Air leaks were graded daily as forced expiratory only, expiratory only, inspiratory only, or continuous. All CTs were kept on 20 cm of suction until postoperative day 2 and were then converted to water seal. On postoperative day 3, if both a pneumothorax and AL were present, the CT was placed to 10 cm H2O of suction. If a pneumothorax was present without an AL, the CT was returned to 20 cm H2O of suction. Air leaks that persisted after postoperative day 7 were treated with talc slurry.
There were 101 patients (67 men); on postoperative day 1, 26 had ALs and all were expiratory only. Univariable analysis showed a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) (p = 0.005), increased age (p = 0.007), increased ratio of residual volume to total lung capacity (RV/TLC) (p = 0.04), increased RV (p = 0.02), and an increased functional residual capacity (FRC) (p = 0.02) to predict the presence of an AL on postoperative day 1. By postoperative day 2, 22 patients had expiratory ALs. After 12 hours of water seal, 13 of the 22 patients' ALs had stopped, and 3 more sealed by the morning of postoperative day 3. However, 2 of the 6 patients whose ALs continued experienced a pneumothorax. Five of the 6 patients with ALs on postoperative day 4 still had ALs on postoperative day 7, and all were treated by talc slurry through the CT. All ALs resolved within 24 hours after talc slurry.
Most ALs after pulmonary resection are expiratory only. A low FEV1/FVC ratio, increased age, increased RV/TLC ratio, increased RV, and an increased FRC were predictors of having an ALs on postoperative day 1. Conversion from suction to water seal is an effective way of sealing expiratory AL, and pneumothorax is rare. If an expiratory AL does not stop by postoperative day 4 it will probably persist until postoperative day 7, and talc slurry may be an effective treatment.
漏气是肺切除术后常见的并发症，但在其处理上尚无共识。
将一种胸管及漏气处理算法前瞻性地应用于101例连续接受择期肺切除术的患者。漏气每天按仅用力呼气时漏气、仅呼气时漏气、仅吸气时漏气或持续性漏气进行分级。所有胸管在术后第2天前均保持20 cm水柱的负压吸引，之后改为水封。术后第3天，若同时存在气胸和漏气，胸管置于10 cm水柱负压吸引。若仅存在气胸而无漏气，胸管恢复至20 cm水柱负压吸引。术后第7天仍持续的漏气用滑石粉悬液治疗。
共101例患者（67例男性）；术后第1天，26例有漏气，均为仅呼气时漏气。单因素分析显示，1秒用力呼气量与用力肺活量比值（FEV1/FVC）低（p = 0.005）、年龄增加（p = 0.007）、残气量与肺总量比值（RV/TLC）增加（p = 0.04）、残气量增加（p = 0.02）以及功能残气量（FRC）增加（p = 0.02）可预测术后第1天存在漏气。至术后第2天，22例患者存在呼气时漏气。水封12小时后，22例患者中有13例漏气停止，术后第3天上午又有3例漏气停止。然而，6例漏气持续的患者中有2例发生了气胸。术后第4天有漏气的6例患者中，5例在术后第7天仍有漏气，均通过胸管注入滑石粉悬液治疗。注入滑石粉悬液后24小时内所有漏气均消失。
肺切除术后多数漏气为仅呼气时漏气。FEV1/FVC比值低、年龄增加、RV/TLC比值增加、残气量增加以及功能残气量增加是术后第1天发生漏气的预测因素。从负压吸引改为水封是封闭呼气时漏气的有效方法，气胸罕见。若呼气时漏气在术后第4天仍未停止，可能会持续至术后第7天，滑石粉悬液可能是一种有效的治疗方法。
