Resident physician training in bedside pleural procedures: A one-year experience at a teaching hospital

Abstract Background and objective This study aims to quantify bedside pleural procedures performed at a quaternary teaching hospital describing technical and epidemiological aspects. Materials and methods The authors retrospectively reviewed consecutive patients who underwent invasive thoracic bedside procedures between March 2022 and February 2023. Results 463 chest tube insertions and 200 thoracenteses were performed during the study period. Most procedures were conducted by 1st-year Thoracic Surgery residents, with Ultrasound Guidance (USG). There was a notable preference for small-bore pigtail catheters, with a low rate of immediate complications. Conclusion Bedside thoracic procedures are commonly performed in current medical practice and are significant in surgical resident training. The utilization of pigtail catheters and point-of-care ultrasonography by surgical residents in pleural procedures is increasingly prevalent and demonstrates high safety.

Application effects of thoracoscopic resection of a pulmonary bulla without tube thoracostomy / 中国基层医药

Objective:To investigate the application effects of thoracoscopic resection of a pulmonary bulla without tube thoracostomy.Methods:A total of 60 patients who underwent thoracoscopic resection of a pulmonary bulla from January 2019 to January 2021 in Urumqi Youai Hospital were included in this study. They were randomly divided into an observation group and a control group ( n = 30/group). Tube thoracostomy was performed in the control group but not in the observation group. Oxygenation index measured at 24 hours, pain score measured at 24, 48 and 72 hours after surgery, complications, hospital stay, and total hospitalization expense were compared between the two groups. Results:There was no significant significance in oxygenation index measured at 24 hours between the two groups ( P > 0.05). At 24, 48 and 72 hours after surgery, pain score in the observation group was (2.6 ± 1.2) points, (1.5 ± 0.8) points, and (0.9 ± 1.1) points, respectively, which were significantly lower than (4.5 ± 1.4) points, (3.8 ± 1.5) points, (2.8 ± 1.7) points in the control group ( t = 1.34, 1.13, 0.92, all P < 0.05). The total incidences of postoperative pleural effusion and complications in the observation group were 3.3% (1/30) and 20.0% (6/30), respectively, which were significantly lower than 26.7% (8/30) and 46.7% (14/30) in the control group ( χ2 = 6.40, 4.25, both P < 0.05). The postoperative hospitalization time and total hospitalization expense in the observation group were (3.4 ± 0.8) days and (1.1 ± 0.3) × 10 000 yuan, respectively, which were significantly shorter or less than (6.5 ± 1.4) days and (1.4 ± 0.5) × 10 000 yuan in the control group ( t = 10.22, -1.88, both P < 0.05). Conclusion:Thoracoscopic resection of a pulmonary bulla without tube thoracostomy is feasible and safe, which has a certain promotion value.

Application of ultrafine thoracic drainage tube for postoperative lung tumors after pulmonary uniportal video-assisted thoracoscopic surgery / 中华胸心血管外科杂志

Objective:To investigate the clinical application of ultrafine thoracic drainage tube(Abel, 8FR, 20 cm) after pulmonary uniportal video-assisted thoracoscopic surgery lung tumors.Methods:A total of 2 031 patients who doing lung tumor surgery in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from May 2015 to July 2020 were retrospectively enrolled. According to the types of thoracic drainage tubes, they were divided into the ultrafine drainage tube group(1 026 cases) and the conventional drainage tube group(1 005 cases). The groups were compared in terms of postoperative thoracic drainage at 24 h, 48 h and 72 h, postoperative hospital stay, drainage time, postoperative pain index at three days, postoperative analgesia times and postoperative complications.Results:There was no significant difference between two groups in terms of the postoperative thoracic drainage at 24h, 48h, 72h and drainage time( P>0.05). Notably, there were significant differences between two groups in terms of the postoperative hospital stay, postoperative pain index at three days, postoperative analgesia times and postoperative complications( P<0.05). Conclusion:The use of ultrafine thoracic drainage tube after lung tumor surgery is safe and reliable, can better postoperative drainage, achieve the purpose of relieving pain, speeding up postoperative rehabilitation, and convenient nursing, worthy of clinical promotion and application.

Analysis use different diameter thoracic drainage tube with negative pressure drainage ball on the chest drainage effect after biportal thoracoscopic radical resection for lung cancer / 中华胸心血管外科杂志

Objective:To explore the chest drainage effect of use different diameter thoracic drainage tube after biportal thoracoscopic radical resection for lung cancer.Methods:300 patients with lung cancer who received biportal thoracoscopic radical resection were divided into group A and group B from January 2018 to September 2020. Group A: 150 patients with single 28# thoracic drainage tube after surgery. Group B: 150 patients with single 20# thoracic drainage tube and a negative pressure drainage ball after surgery. The postoperative drainage volume, drainage time, postoperative pain, postoperative thoracic puncture, hospital stay and total hospital expenses were compared.Results:No significant difference between the two groups in terms of sex, age, postoperative pathological type and resection range. There no significant difference between the two groups in total drainage volume [(1 010.31±525.29)ml vs.(985.35±403.93)ml] and total drainage time [(5.69±2.55)days vs.(5.42±1.94)days]. The difference of different diameter thoracic drainage tube used [(5.69±2.55)days vs.(2.88±0.64)days] was statistically significant. There were significant differences between two groups in terms of hospital stay[(12.64±2.89)days vs.(11.25±1.62)days] and total hospital expenses[(62 899.00±1 588.82) yuan vs.(64 327.00±3 587.04)yuan]. No significant differences on the postoperative first day, second day and third day in VAS pain scores. However, on the postoperative fifth day, the difference was statistically significant. In addition, the rate of group A postoperative thoracic puncture was 10%, group B was 0, the comparison was statistically significant.Conclusion:Using a single thin thoracic drainage tube and plus a negative pressure drainage ball after biportal thoracoscopic radical resection for lung cancer will not cause pain increase, shorten hospital stay days, control the rate of postoperative thoracic puncture and then reduce patients total hospital expenses.

Relationship between drainage diameter and prognosis of patients with thoracic trauma during closed thoracic drainage / 国际外科学杂志

Objective:To explore the relationship between the diameter of drainage used in closed thoracic drainage (CTD) and the prognosis of patients with thoracic trauma.Methods:This study was a retrospective cohort study, a total of 146 patients who were admitted to the 971st Navy Hospital due to thoracic trauma from April 2017 to June 2021 and received closed thoracic drainage were selected as the research subjects. According to the prognosis, they were divided into a good group ( n=96) and a poor group ( n=50), and the clinical efficacy, general data and postoperative complications of the two groups were compared and analyzed. Multivariate Logistic regression was used to analyze the risk factors for poor prognosis, and a nomogram prediction model was established, and the model was evaluated. The relationship between the size of drainage diameter and the prognosis of patients with thoracic trauma was analyzed by Pearson correlation. The normally distributed measurement data was expressed by the ( ± s), and the independent samples t test was used for comparison between groups; The chi-square test was used for comparison of count data between groups. Results:The clinical efficacy of CTD was good, with a total effective probability of 87.67%; and 3 weeks after surgery, the patient′s prognosis was good, with a good prognosis probability of 65.75%. Logistic analysis showed that age 60 years old ( OR=1.501, 95% CI: 1.105-2.177), excipient replacement time of 2-3 d ( OR=2.543, 95% CI: 1.729-3.168), drainage bottle higher than thoracic cavity ( OR=1.692, 95% CI: 1.314-2.482), long wound healing time ( OR=1.971, 95% CI: 1.479-2.720), frequent cough ( OR=2.259, 95% CI: 1.564-2.924), and drainage tube diameter 16 F ( OR=3.087, 95% CI: 2.074-3.793) were independent risk factors for poor prognosis ( P<0.05). The size of drainage diameter was positively correlated with hospitalization and wound healing time, pain VAS score ( P<0.05), and negatively correlated with Barthel Index ( P<0.05). Conclusion:Drainage tube diameter 16 F is one of the independent risk factors for poor prognosis of patients. The smaller the drainage diameter, the shorter the postoperative hospital stay, faster wound healing, lighter pain and stronger ability of life and activity.

Influencing factors analysis of thoracic drainage time after da Vinci robot lung cancer surgery and preventive solution / 中国胸心血管外科临床杂志

@#Objective    To explore the factors that affect the drainage time of da Vinci robot lung cancer surgery, to analyze the coping strategies, and to provide a basis for shortening the drainage time of patients after surgery and speeding up the patients' recovery. Methods    The clinical data of 131 patients who underwent da Vinci robot lung cancer surgery at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from January 2019 to October 2019 were retrospectively analyzed. Among them, 68 were males and 63 were females, with an average age of 59.84±9.66 years. According to the postoperative thoracic drainage time, the patients were divided into two groups including a group A (drainage time≤ 5 days) and a group B (drainage time >5 days). Univariate analysis and logistic multivariate regression analysis were used to analyze the factors that may affect postoperative drainage time, and the correlation between different influencing factors and thoracic drainage time after da Vinci robot lung cancer surgery. Results    Logistic multivariate analysis showed that age≥60 years (P=0.014), diabetes mellitus (P=0.035), operation time≥130 min (P=0.018), number of lymph node dissections≥15 (P=0.002), and preoperative albumin<38.45 g/L (P=0.010) were independent factors affecting the drainage time of da Vinci robot lung cancer surgery. Conclusion    For elderly patients with diabetes mellitus during the perioperative period, blood glucose should be actively controlled, reasonable surgical strategies should be formulated to ensure the safety and effectiveness of the operation, while reducing intraoperative damage and shortening the operation time. After the operation, patients should be guided to strengthen active coughing, expectoration and lung expansion. Thereby it can shorten drainage time and speed up the recovery of patients after operation.

Analysis of the safety and feasibility of two closed thoracic drainage methods after video-assisted thoracoscopic lung volume reduction surgery / 中国胸心血管外科临床杂志

@#Objective    To investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery. Methods    Retrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group. Results    There was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). Conclusion    It is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.

Analysis of the effect of different chest drainage after uniportal video-assisted thoracoscopic radical operation for lung cancer / 中华胸心血管外科杂志

Objective@#To investigate the effect of different thoracicdrainage methods afte single holethoracoscopicsurgery for lung cancer.@*Methods@#200 patents with lung cancer undergoing single holethoracoscopicsurgery were divided into two groups : group A and group B in the first affliliated Hospital of Suzhou University from April 2014 to December 2016. Group A: 100 patients with 30#single thoracic drainage tube after operation. Groupe B: 100 patients with 30#thoracic drainage tube plus a negative pressure drainage tube after operation. The amount of thoracic drainage tube , drainage time , postoperative chest puncture, postoperative pain, hospital stay and total costs of hospitalization were observed in both groups.@*Results@#There was no difference in age, sex, pathological type and pulmonary lobectomy between the two groups. Total thoracic drainage[(1 007.4±512.95)ml vs.(982.35±359.93)ml]and totaltube time[(5.71±2.61)days vs.(5.43±1.91) days] had no significant difference between the two groups. There was a significant difference in the length of 30#thoracic drainage tube [(5.71±2.61)days vs.(2.9±0.61)days]between the two groups. The difference of hospitalization time[(12.05±2.93)days vs.(13.45±4.15)days]and hospitalization expenses[(63 376.47±1 615.82)yuan vs.(64 449.82±3 650.04)yuan]was statistically significant. The rate of rethoracotomy in gruop A was 7%, the rate of rethoracotomy in group B was 0, the comparison between the two groups was statistically significant. VAS pain scores were compared on the first day and the second day, there was no significant difference on the third day after operation. On the fifth day after operation, the difference was statistically significant.@*Conclusion@#Adding a negative pressure drainage tube on the basis of using a single thoracoscopic drainage tube for radical resection of lung cancer after single hole thoracoscopic surgery will not increase postoperative pain of patients, significantly shorten postoperative hospitalization time, effectively control postoperativerethoracopunchure rate, thus effectively reduce postoperative hospitalization costs of patients.

Comparison of the single or double chest tube applications after lobectomy: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To compare the efficacy of the single tube (ST) and double tube (DT) for closed thoracic drainage after lobectomy. Methods     The PubMed, Medline, EMbase, Web of Science, CNKI, Wanfang Database, VIP database and CBMdisc from inception to March 30, 2018 were searched by computer to identify randomized controlled trial (RCT) about ST and DT drainage after lobectomy. Based on inclusion and exclusion criteria the literature was screened. Meta-analysis was performed using RevMan 5.3 software. Results     Twelve RCTs were enrolled in this meta-analysis, including 1 442 patients. Compared with the patients using DT after lobectomy, the patients using ST had significantly less postoperative pain (MD=–0.64, 95%CI –0.71 to –0.56, P<0.000 01) and shorter duration of drainage (MD=–0.62, 95%CI –0.78 to –0.46, P<0.000 01) and hospital stay (MD=–0.55, 95%CI –0.80 to –0.29, P<0.000 1). Besides, there was no significant difference in postoperative complications (RR=1.11, 95%CI 0.83 to 1.49, P=0.49), air leaks (RD=0.03, 95%CI –0.02 to 0.08, P=0.19) and the redrainage rate (RR=0.89, 95%CI 0.51 to 1.54, P=0.67). Conclusion    ST drainage after lobectomy is effective, which reduces postoperative pain and duration of hospital stay and drainage, and moreover, does not increase the postoperative complications and redrainage rate.

Analysis of the effect of different chest drainage after uniportal video-assisted thoracoscopic radical operation for lung cancer / 中华胸心血管外科杂志

Objective To investigate the effect of different thoracicdrainage methods afte single holethoracoscopicsurgery for lung cancer. Methods 200 patents with lung cancer undergoing single holethoracoscopicsurgery were divided into two groups :group A and group B in the first affliliated Hospital of Suzhou University from April 2014 to December 2016. Group A:100 patients with 30#single thoracic drainage tube after operation. Groupe B:100 patients with 30#thoracic drainage tube plus a negative pressure drainage tube after operation. The amount of thoracic drainage tube , drainage time , postoperative chest puncture, postoperative pain, hospital stay and total costs of hospitalization were observed in both groups. Results There was no difference in age, sex, pathological type and pulmonary lobectomy between the two groups. Total thoracic drainage [(1007.4±512.95)mlvs.(982.35±359.93)ml]andtotaltubetime[(5.71±2.61)daysvs.(5.43±1.91)days]hadno significant difference between the two groups. There was a significant difference in the length of 30 # thoracic drainage tube [(5.71±2.61)daysvs.(2.9±0.61)days]betweenthetwogroups. Thedifferenceofhospitalizationtime[(12.05±2.93) daysvs.(13.45±4.15)days]andhospitalizationexpenses[(63376.47±1615.82)yuanvs.(64449.82±3650.04)yuan] was statistically significant. The rate of rethoracotomy in gruop A was 7％, the rate of rethoracotomy in group B was 0, the comparison between the two groups was statistically significant. VAS pain scores were compared on the first day and the second day, there was no significant difference on the third day after operation. On the fifth day after operation, the difference was sta-tistically significant. Conclusion Adding a negative pressure drainage tube on the basis of using a single thoracoscopic drain-age tube for radical resection of lung cancer after single hole thoracoscopic surgery will not increase postoperative pain of pa-tients, significantly shorten postoperative hospitalization time, effectively control postoperativerethoracopunchure rate, thus ef-fectively reduce postoperative hospitalization costs of patients.

Value of intrathoracic contrast-enhanced ultrasound in closed thoracic drainage of pleural effusion / 第二军医大学学报

Objective To investigate the value of intrathoracic contrast-enhanced ultrasound in the treatment of pleural effusion. Methods Forty-four patients in our hospital were selected; they had stopped drainage during closed thoracic drainage and had residual pleural effusion determined by pathogenetic condition. The resistance in the catheter during normal saline flushing, whether the effusion could be drained and the effusion traits, and the enhancement of catheter, chest wall soft tissue and pleural cavity after contrast-enhanced ultrasound were all observed. Clinical and ultrasound examination was used to judge whether the catheters were out of the effusion cavity and the accuracies of the two examination methods were compared. Results When the catheter was located in the effusion cavity, contrast-enhanced ultrasound showed a linear enhancement in the catheter and a slow enhancement in the effusion cavity; when the catheter was removed, contrast-enhanced ultrasound showed a short linear enhancement in the catheter, a limited area of enhancement in the chest wall soft tissue and no enhancement in the effusion cavity. In clinical judgment, 8 catheters were located in the effusion cavity, and 36 cases were removed. In ultrasound judgment, 29 catheters were located in the effusion cavity, 14 cases were removed, and 1 case could not be judged. Taking whether there is still liquid extraction 24 h after saline flushing or drug injection as the standard of catheter removing, we found that the accuracy of contrast-enhanced ultrasound in determining catheter removing was significantly higher than that of the clinical judgment (97.73% [43/44] vs 50.00% [22/44], P0.01). Conclusion Intrathoracic contrast-enhanced ultrasound can accurately judge the position of catheters and the internal condition of the effusion cavity. It provides a basis for further treatment of pleural effusion.

The clinical application of pigtail catheter thoracic closed drainage in the first diagnosed as spontaneous pneumothorax in adolescents / 中华胸心血管外科杂志

Objective To investigate the two kinds if thoracic cavity closed drainage contrast analysis and evaluate the pigtail catheter for treatment of spontaneous pneumothorax in adolescents.Methods This study included 53 adolescent patients with the first spontaneous pneumothorax in Huaihe Hospital of Henan University between January 2013 and December 2015.According to the different operation ways,they were divided into two groups:silicone tube and pigtail catheter group.The following post-operative data was evaluated:pain,subcutaneous emphysema,drainage time,hospital stay,new drain insertion,and wound healing at the site of insertion.Results There were 32 patients in the silicone tube group and 21 ones in the other group.The data revealed a significantly reduced the operation time and pain in the pigtail catheter group compared to the chest tube group(P ＜ 0.05).However,no statistical differences in success rate,postoperative hospital stay and complications incidence were found between the 2 groups.Conclusion Compared to common chest tube,the employment of pigtail catheter in the adolescent patients with pneumothorax significantly reduces the operation time and pain.Nevertheless,no statistically significant differences were discovered in success rate,postoperative hospital stay and the incidence of complications between the two corresponding groups.Thus pigtail catheter is competent in terms of closed thoracic drainage in adolescents who are the first diagnosed as spontaneous pneumothorax.

Treatment of spontaneous pneumothorax by mechanical pleurodesis / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and pleurodesis for spontaneous pneumothorax. Methods    A retrospective analysis of 157 patients with spontaneous pneumothorax undergoing VATS from January 2012 to March 2016 in our hospital was done. According to different treatments, patients were divided into two groups: a group A (65 patients receving pleurodesis, 52 males and 13 females with a mean age of 34.77 years ranging from 17 to 73 years) and a group B (92 patients without pleurodesis, 76 males and 16 females with a mean age of 34.66 years ranging from 16 to 72 years). In the group A 29 patients underwent closed thoracic drainage; while in the group B there were 39 patients. Results    The patients were followed up for 3 months to 4 years. The recurrence rate of the group A was lower than that of the group B, but the difference was not statistically significant. For patients receving closed thoracic drainage preoperatively, intraoperative drainage volume at postoperative 24 h in the group A was more than that of the group B, but postoperative hospital stay was less than that of the group B (P<0.05). For patients not receving closed thoracic drainage preoperatively, drainage volume at postoperative 24 h, total drainage volume, postoperative hospital stay in the group A were more than those of the group B (P<0.05). Conclusion    Pleurodesis can not reduce the recurrence rate of spontaneous pneumothorax. Preoperative closed thoracic drainage combined with intraoperative pleurodesis can effectively reduce postoperative hospitalization; therefore pleurodesis is recommended. If preoperative closed thoracic drainage is not adopted, surgery without pleurodesis can effectively reduce thoracic drainage at postoperative 24 h, total drainage volume and hospital stay and the perioperative results are better; therefore mechanical pleurodesis is not recommended.

Comparison of open thoracic drainage and conventional thoracic drainage tube applicated in patients after pneumonectomy / 中国基层医药

Objective To compare the clinical effects between open thoracic drainage and conventional thoracic drainage tube applicated in patients after pneumonectomy.Methods 120 cases after pneumonectomy were selected as research subjects,and they were randomly divided into two groups according to the digital table,60 cases in each group.The control group was given conventional thoracic drainage tube,while the observation group received open thoracic drainage,The clinical effects were compared between the two groups.Results The length of hospital stay,total drainage and retention time of drainage tube in the observation group were significantly higher than those inthe control group,the overall incidence rate of complications in the observation group was 13.33％,which was lower than 23.33％ in the control group,but there were no statistically significant differences (t =1.60,1.97,0.72,x2 =2.00,all P ＞ 0.05).Conclusion Open thoracic drainage has similar clinical effect with conventional thoracic drainage tube on patients after pneumonectomy,it is worthy to be promoted clinically.

Impact of rhBNP infusion on early postoperative recovery after total cavo-pulmonary connection surgery / 中华胸心血管外科杂志

Objective To compare the effects of rhBNP on the discharge time and pleural effusion in children with total cavo-pulmonary connection, and to provide a more reasonable method for the clinical treatment of postoperative children. Meth-ods Retrospective analysis of Jan 2016 to Jan 2017 during the hospital 40 cases of complex congenital heart disease in children with total cavo-pulmonary connection clinical data, of which 5 cases due to postoperative thrombosis or postoperative venous pressure was too high and had a second Fontan surgery, the patients excluded from the inclusion criteria. 9 cases of children re-turned to the ward after surgery, such as cardiac, diuretic and other conventional treatment based on the application of unequal dose of rhBNP(3-11 days) for the rhBNP group, 26 cases of conventional treatment of children with conventional treatment group. By comparing the early postoperative survival rate, the number of days of hospital stay and the retention time of the tho-racic drainage between the two groups. Results There were no significant differences in the time of cardiopulmonary bypass, postoperative ventilator use time, ICU time and positive inotropic drug scores in all the two groups. All the patients underwent preoperative examination with total cavo-pulmonary connection were alive and healthy discharge. The median hospital stay was 18 days in the rhBNP group(11-33 days, mean 19. 2 days), and the median length of hospital stay was 28 days in the routine treatment group(9 to 95 days, mean 34. 4 days). The difference of hospitalization days between the two groups was statistically significant(P=0. 038). In the retention time of the thoracic drainage tube, the median thoracic drainage tube retention time was 14 days(9-27 days, mean 15. 6 days) in the rhBNP group and 23 days in the conventional treatment group(7-91 days, mean 30. 9(P=0. 046). All the patients had no adverse effects such as excessive fluid load, intractable hypotension and liver or kidney function injury. Conclusion RhBNP can be used safely in pediatric cardiac surgery. Compared with the convention-al treatment group, rhBNP has advantages in the early discharge time and the time of thoracic drainage tube removal in children with total cavo-pulmonary connection.

Comparison of thoracic drainage by two kinds of devices after single-port video-assisted thoracoscopic surgery in treatment of primary spontaneous pneumothorax / 中国内镜杂志

Objective To explore the clinical values of the modified thoracic drainage devices that were applied in treatment of primary spontaneous pneumothorax patients who underwent single-port video-assisted thoracoscopic surgery. Methods Clinical data of 82 primary spontaneous pneumothorax patients who underwent single-port video-assisted thoracoscopic lung wedge resection and pleurodesis from January 1st, 2015 to August 31st, 2016 was analyzed retrospectively. These patients, according to the thoracic drainage devices, were divided into traditional group (Group A, n = 42) or modified group (Group B, n = 40). These statistical data, including duration of thoracic drainage, lengths of hospital stay, duration of using antibiotic, amounts of pleural drainage, scales of pain, and complications of the two groups of patients in postoperative stage, were compared. Results There was no significant differences (P > 0.05) in volumes of thoracic drainage while there were significant differences (P < 0.05) in duration of thoracic drainage, lengths of hospital stay, duration of using antibiotic, scales of pain, and complications in postoperative stage between the two groups. And patients in group B had shorter time of thoracic drainage, hospital stay, and using antibiotic, lower scales of pain and rates of complications when compared with group A. Conclusion There are some clinical values of application of modified thoracic drainage devices in treatment of primary spontaneous pneumothorax underwent single-port video-assisted thoracoscopic surgery, because of it could give the patients fast recovery and made the operations simpler.

Effect of closed chest drain on wound closure of primary spontaneous pneumothorax / 天津医药

Objective To explore the relationship between visceral pleura closure of primary spontaneous pneumotho?rax (PSP) using different diameters of drainage tube and the time of implementing closed chest-drain. Methods According to the diameters of tubes for chest drain they used, 214 patients with PSP were divided into standard tube group (136 cases) and fine catheter group (78 cases). Patients in standard tube group who were inserted chest drain for≤1 d,≤3 d,≤6 d,>6 d included 48, 43, 29 and 16 cases respectively while their counterpart in fine catheter group include 24, 23, 17, 14 cases re?spectively. Closed time of crevasse were noted and incidence of preoperative closed pneumothorax converting into open pneu?mothorax, subcutaneous emphysema and prolonged pain after operation were all recorded. Results There is no statistical difference in closing time of crevasse nor in the distribution of various drainage times (proportions of≤6 d and>6 d are low?er than proportions of≤1 d and≤3 d) between standard tube group [(4.76 ±1.65) d] and fine catheter group [(4.54±1.67) d] (t=0.963). However, in both standard tube group and fine catheter group, closing time of crevasse is shorter if drainage time≤6 d or>6 d than if it≤1 d and≤3 d. Closing time of crevasse show negative correlation with period of chest drain in?sertion in both standard tube group and fine catheter group (P<0.05). The rate of converting from close pneumothorax into open pneumothorax were 51.96%(53/102) and 36.21%(21/58) respectively in standard pipe group and fine catheter group. Furthermore, the incidence of subcutaneous emphysema and prolonged pain were all higher than those in standard tube group than those in the fine catheter group (P<0.05). Conclusion Using closed chest drain to treat patients with PSP, di?ameter of the drain tube did not affect closing time of crevasse. But longer insertion period of chest drain can reduce closing time of crevasse.

Guiding values of different lung compressed forms in spontaneous pneumothorax on the choice of the treatment / 天津医药

Objective To evaluate the guiding values of different lung compressed forms in the choice of the treat?ment of spontaneous pneumothorax. Methods Based on lung compressed forms on anterior-posterior chest X-ray , a total of 219 spontaneous pneumothorax patients were divided into the periphery shape group (n=127) and irregular shape group (n=92). We observe the relationship between lung compressed form with the times of previous closed thoracic drainage,the cure rate of closed chest drain at the 7th day,length that closed thoracic drainage cure pneumothorax and the incidences of the surgical pleural adhesion. Results We found that the incidence of irregular lung compression in 0, 1 and 2 times of re?ceiving previous drainage were 11.71%(13/111), 57.89%(22/57) and 90.19%(46/51) respectively. Its incidence increased with the times of previous closed chest drain (χ2=96.339, P<0.01). In total, 94 patients (85 of which were cured until the 7th day) and 30 patients (11 of which were cured until the 7th day) were cured using close chest drain in peripheral shape and ir?regular shape group. And the 7th day cure rate is lower in irregular group than that in the peripheral shape. [36.7%(11/30) vs 90.4%(85/94),χ2=37.596, P<0.01]. What’s more, patients in irregular group need longer time to cure pneumothorax than patients in peripheral shape did [d:10.1±4.87 vs 4.00±2.07, t=9.806, P<0.01]. Among the 95 patients who underwent surgi?cal treatment in both groups, the incidence of pleural adhesion is higher in irregular shape group than that in peripheral shape group [91.9%(57/62)vs18.2%(6/33),χ2=52.445, P<0.01]. Conclusion The 7th day cure rate in patients with pe?ripheral shape lung compressed form is higher than patients in irregular lung compressed form using closed chest drain with fewer incidence of pleural adhesion and shorter cure time. Those with irregular lung compression is more appropriate for sur?gical treatment.

Clinical observation of closed thoracic drainage by minimal invasive in treating spontaneous pneumothorax / 中国医师进修杂志

Objective To investigate the clinical curative effect of closed thoracic drainage by minimal invasive with needle catheter in treating spontaneous pneumothorax.Methods Seventy-six patients with spontaneous pneumothorax were divided into two groups randomly,the control group was treated by traditional thick tube closed thoracic drainage,the experimental group was treated by the needle catheter minimally invasive thoracic closed drainage.Compared clinical curative effect,pulmonary reexpansion time,the wound healing time,the degree of pain and the occurrence of complication between two groups.Results The effective rate of experimental group and control group was 91.9％ (34/37) and 92.3％ (36/39),the pulmonary reexpansion time of experimental group and control group was (5.38 ± 2.21) d and (5.29 ± 2.27) d,there was no significant difference (P ＞ 0.05).The pain scores during draining and wound thealing time of experimental group and control group was (1.32 ±0.92) scores,(2.93 ± 1.14) scores,(2.13 ± 1.40) d and (5.32 ± 1.78) d,there was significant difference (P ＜ 0.01).Complication such as subcutaneous emphysema,dislodgment of the catheter and wound infection in experimental group was lower than that in control group.Conclusions The effect of needle catheter minimally invasive thoracic closed drainage in spontaneous pneumothorax is better,simple and less invasive.The wound healing time is short,and little pain.It is worthy of promotion.

The effect and safety of thoracic drainage by central venous catheter in critical patients with pleural effusion / 中国中西医结合急救杂志

Objective To investigate the effect and safety of thoracic drainage by central venous catheter in critical patients with pleural effusion. Methods A prospective study was carried out,in which 46 critical patients with pleural effusion admitted to department of critical care medicine were included,and according to the types of their primary diseases to make matched pairs,and they were divided into two groups:conventional drainage control group and central venous catheter drainage observation group(each 23 cases). The drainage effect and complications were compared between the two groups,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score, quantitative pleural effusion and the counts of white blood cells(WBC)and of platelets(PLT),the levels of prothrombin time(PT),procalcitonin(PCT)and C-reactive protein(CRP),etc. were measured on the baseline and 24 hours after the operation. Results There were no significant differences in the APACHEⅡ score,quantitative pleural effusion,amount and duration of drainage,as well as the levels of WBC,PLT,PT and PCT between group control and observation(all P>0.05). The post-drainage CRP(μg/L)level in group observation was much lower than that in group control(77.26±67.20 vs. 106.13±66.23,P0.05). Conclusions In the comparison between the conventional drainage and thoracic drainage with central venous catheter,the therapeutic effects for treatment of critical patients with pleural effusion were similar, but the stress was milder and the incidence of complications was lower in the latter group. Therefore,the thoracic drainage with central venous catheter is a safe,effective and alternative method to substitute the conventional drainage for critical patients with pleural effusion.