The routine use of chest drainage tube after lobectomy is helpful for pleural effusion to be discharged from the body, eliminate the residual cavity of the chest and promote the reexpansion of the lung. It is very important to reduce pulmonary infection and timely detect intrathoracic bleeding and other postoperative complications.Therefore, the selection of chest drainage tube should first consider the safety and effectiveness of patients.With the promotion and use of the concept of ERAS and minimally invasive surgery deeply rooted in the hearts of the people in recent years, we realize that postoperative pain and diaphragm stimulation caused by thick chest tubes may not be conducive to the accelerated recovery of patients after operation.So, it is of great clinical significance to explore whether 8F ultrathin chest drainage tube is safe and reliable compared with traditional thick chest drainage tube, in order to accelerate the recovery of patients.
Due to the pressure of the drainage tube on the intercostal nerve and diaphragm, the placement of the closed thoracic drainage tube will cause postoperative chest This study showed that there were statistically significant differences in pain scores between the two groups on POD 1,2 and 3 after surgery(3.72 ± 0.65point vs 3.94 ± 0.67point,P = 0.027 ;2.72 ± 0.93point vs 3.13 ± 1.04point,P = 0.016;1.87 ± 0.65point vs 2.39 ± 1.22point,P = 0.005).Pain scores in group A were significantly better than those in group B.Postoperative pain increases, which affects the recovery of patients' respiratory function and increases the risk of postoperative respiratory complications.The postoperative pain was reduced, which enhanced the initiative of cough and sputum, promoted lung expansion, reduced lung infection, and was more conducive to ambulation.
The operation of 8F ultrafine chest drainage tube is simple, the extubation is convenient and quick.After extubation, the incision closes naturally and it is not easy to inject air.Just apply the normal dressing externally.However, after the extubation of 24F thick thoracic duct, in order to avoid the intake of air or leakage of drainage outlet, vaseline gauze or reserved suture ligation is needed, which is more complicated and risky, and long surgical scar will be left after healing, affecting the appearance and leaving psychological trauma that is difficult to heal for the patient.After switching to ultrafine chest drainage tube, the incision was small, the perivascular tissue inflammatory response was mild, postoperative scar was small, and it was more beautiful.
In this study, the drainage days in group A were shorter than those in group B((4.25 ± 1.79d vs 6.04 ± 1.96d,P = 0.000), the postoperative hospital stay in group A were shorter than those in group B(8.46 ± 2.48d vs 9.37 ± 1.70d,P = 0.014),and the total postoperative drainage volume was also lower than that in group B(1100.42 ± 701.57 ml vs 1369.39 ± 624.25 ml,P = 0.021). The differences were statistically significant.The inner wall of the ultrafine chest drainage tube is smooth, with strong anti-coagulation ability and good flexibility. It can be coiled in the costophrenic angle or followed between the lung and chest wall, making drainage more smooth and sufficient.However, the texture of the thick chest tube is hard, and it is not easy to be completely placed in the costophrenic angle or followed between the chest wall and the lung lobe. Therefore, it may compress the lung lobe and diaphragm muscle, and stimulate the increase of pleural effusion.
Although the inner diameter of 8F ultrafine chest drainage tube is smaller than that of traditional 24F drainage tube, patients ambulate earlier, promote fluid accumulation and drainage faster due to its advantage in pain management, and the risk of atelectasis and pulmonary infection does not increase significantly compared with the thick drainage tube(5.97% vs 10.45%,5.97% vs8.96%,P ༞0.05).If the lung recovers well and coughs without bubble overflow, patients using 8F ultrafine chest drainage tube can replace the water-sealed drainage bottle as the drainage bag, so that patients can ambulate more easily, which is also the convenience of the thin drainage tube.
For patients with postoperative air leakage, drugs such as high glucose can be injected into the chest to promote thoracic adhesion.The operation of 8F ultrafine chest drainage tube is simple and aseptic, while injecting drugs into thoracic cavity through traditional 24F chest drainage tube is tedious and easy to be contaminated.
Among the 67 patients in group A, 2 patients with intrathoracic hemorrhage were found in the postoperative resuscitation room and underwent secondary surgery for hemostasis, and all of them were cured and discharged. The results showed that although the 8F ultrafine chest drainage tube had a thicker and smaller inner diameter, it could still find the intrathoracic hemorrhage in time and effectively.
8F ultrafine chest drainage tube also has several problems:(1) Among the cases in group A, the reasons for the chest tube reinsertion in 3 patients were drainage tube dislocation. Therefore, the depth of the catheter should be flexibly grasped according to the thickness of the chest wall in clinical practice. It should not be too shallow or too deep. Too shallow may cause the drainage tube to come out, and too deep the drainage tube may bend into an angle in the chest cavity to affect the drainage.(2)The ultrafine chest drainage tube should be placed at another puncture point, not through the surgical incision.Because if the tissue around the tube is not dense enough, there may be fluid seepage around the mouth of the tube;drainage orifice exudation may also occur after extubation.