改良胸腔闭式引流术治疗气胸的临床分析

摘要

Objective:To explore the clinical efficacy of pneumothorax treated with thoracic closed drainage through the 4th intercostal space in the axillary frontline.Methods:From May 2014 to May 2016,100 patients with pneumothorax or pneumothorax with small amount hemothorax were randomly divide into traditional group (56 cases) and improved group (44 cases).Traditional group were treated with thoracic closed drainage through the Second intercostal space in the midclavicular line, and improved group were treated through the 4th intercostal space in the axillary frontline.The operation time,extubation time, pain degree (at the 12th hour,the 24th hour, the 36th hour after operation),drainage effect, cases of drainage pipe blockaged or fall off,cases of incision reuse for VATS (video-assisted thoracoscope surgery), adaptability after operation,satisfaction for incision site in the two groups were compared.Results:There were no significantly difference in the two groups about the operation time,extubation time,pain degree (at the 24th hour, the 36th hour after operation) and drainage effect (P>0.05), however, the pain degree in improved group was lower than that of traditional group (P<0.05).There were no cases of drainage pipe blockaged or fall off in two groups.The incision in improved group were all reused successfully in VATS.The rate in improved group of adaptability after operation were higher than that of traditional group,and the similar results about satisfaction for incision site.Conclusion:In most cases, treating pneumothorax by thoracic closed drainage through the 4th intercostal space in the axillary frontline revealed reliable result, well adaptability and can meet the requirements of the beauty,deserve the clinical expansion.%目的:探讨经腋侧第4肋间胸腔闭式引流术治疗气胸的临床效果.方法:选择2014年5月-2016年5月收治的100例气胸或气胸伴少量血胸患者作为研究对象,随机分为传统组56例和改良组44例.传统组经锁骨中线第2肋间引流,改良组经腋前线第4肋间引流,比较两组患者的置管时间、拔管时间,术后12h、24h和36h疼痛程度,引流效果,引流管堵塞或脱落情况,随后可能的胸腔镜手术切口再利用,术后患者适应性及对伤口是否符合美容要求的情况进行比较.结果:两组患者的置管时间、拔管时间、引流效果、术后24h和36h疼痛程度上差异均无统计学意义(P>0.05);改良组在术后12h疼痛程度低于传统组(P<0.05).对于随后可能的胸腔镜手术,改良组患者均可再利用,且改良组患者的依从性及对置管伤口符合美容要求的比例明显高于传统组(P<0.05).结论:在大多数情况下,经腋侧4肋间放置闭式引流管治疗气胸,是一种引流效果确切、患者适应性好、符合美观要求的胸腔闭式引流方法,值得临床推广.