中心静脉导管和传统胸腔闭式引流治疗创伤性血胸的对照研究

目的 评价应用中心静脉导管行胸腔闭式引流治疗创伤性血胸的有效性、安全性.方法 2003年1月至2007年5月期间浙江大学医学院附属第二医院急诊中心收治的299例创伤性血胸患者按入院日期的单、双号分为导管组(n=156)、胸管组(n=143).导管组从B超定位点按Seldinger法,穿刺置入一次性单腔中心静脉导管,末端接引流袋;传统胸管常规置入,末端接水封瓶.比较两组患者置管的操作时间、治疗成功率、严重并发症发生率、术后镇痛药使用率、手术伤口愈合时间、伤121感染发生率,再对两组中治疗成功的患者,进一步比较其留管时间、相关费用.应用SPSS 13.0软件系统,率的比较采用X2检验,计量资料的比较采用t检验,以P<0.05为差异具有统计学意义.结果 导管组的操作时间、术后镇痛药使用率、手术伤口愈合时间、伤口感染发生率明显低于胸管组(P<0.05),但两组患者的治疗成功率、严重并发症发生率差异无统计学意义(P>0.05).两组中治疗成功的患者,其留管时间、相关费用差异无统计学意义(P>0.05).结论 中心静脉导管引流胸腔积血和传统胸管一样安全、有效,且操作简单、创伤小,较传统胸管更易为医患双方接受.

A controlled study between central venous catheter and conventional chest tube for closed pleural drainage in the treatment of traumatic hemothorax

Objective To evaluate file efficacy and safty of central venous cathetr compared with conventional chest tube for closed pleural drainage in the treatment of traumatic hemothorax Method Totally 299 patients of traumatic hemothorax with middling or large effusions,in emergency department,Second Hospital .Affiliated to Medical College of Zhejiang University,from January 2003 to May 2007,were prospective controlled studied.All the 299 patients of were divided into catheter group (n=156) or tube group(n=143) according as patients'hospitalization date was odd or even number respectively.Patients in catheter group underwent drainage by central venous catheter using the Seldinger technique,and patients in tube group did by conventional chest tube using conventional technique.A unue drainage bag system or a wate seal system was connected with the end of the catheter or the tube respectively.The surgical operation time,the successful rate of treatment,the occurreuce rate of serious complications,the using rate of anodyne,the time of cut concrescence and the occurrence rate of cut infection were compared,and the drainage time and the correlative expenses in patients treated successfully were further compared.The data were analyzed by using t or X2 test with SPSS 13.0.A P value less than 0.05 indicated statistical signficance.Results Compared with robe group,the surgical operation time,the using rate of anodyne,the time of cut concrescence and the occurrence rate of cut infection were significantly decreased(P<0.05) in catheter group.There were not significant differences between two groups in the suecessful rate of treatment and the occurrence rate of serious complications(P>0.05).There were not significant differences between two groups in the drainage time and the corrective expenses of patients treated successfully(>0.05).Conclusions Use of central venous catheter catheters for closed pleural drainage in the treatment of traumatic hemothorax is effective,safe,and well-tolerated.It was more simple and less invasive as a procedure compared with conventional large-bore chest robe.