肋骨置管后胸廓造口术输出量对胸廓再介入需求的影响:容量重要吗?

Negaar Aryan, Jeffry Nahmias, Areg Grigorian, Zoe Hsiao, Avneet Bhullar, Matthew Dolich, Mallory Jebbia, Falak Patel, Jacquelyn Hemingway, Elliot Silver, Sebastian Schubl
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引用次数: 0

摘要

背景:肋骨骨折手术稳定(SSRF)已被证明可改善早期临床疗效。管式胸腔造口术(TT)通常与 SSRF 同时进行,但关于 SSRF 后何时移除 TT 的数据却很少。本研究旨在比较接受胸腔再干预(重新插管、重新插入 TT/pigtail 或视频辅助胸腔手术)的患者与未接受 SSRF+TT 的患者,假设拔管前 TT 输出量增加与胸腔再干预相关:我们对接受 SSRF+TT 的年龄≥ 18 岁的钝性创伤患者进行了单中心回顾性(2018-2023 年)分析。主要结果是胸腔再介入。将移除 TT 后进行胸腔再介入((+)胸腔再介入)的患者与未进行胸腔再介入((-)胸腔再介入)的患者进行比较。次要结果包括TT持续时间和移除前的输出量:在接受 SSRF+TT 手术的 133 名钝性创伤患者中,有 23 人(17.3%)需要进行胸部再介入手术。两组患者的年龄相当。SSRF后,(+)胸腔再介入组的损伤严重程度评分(中位数:29分 vs. 17分,p = 0.035)和TT持续时间(中位数:4天 vs. 3天,p < 0.001)均有所增加。然而,两组患者在 SSRF 后第 1 天(165 毫升对 160 毫升,p = 0.88)以及移除 TT 前 24 小时内(60 毫升对 70 毫升,p = 0.93)的 TT 输出中位数没有差异:本研究表明,超过 17% 的 SSRF+TT 患者需要进行胸腔再介入治疗。结论:这项研究表明,超过 17% 的 SSRF+TT 患者需要进行胸腔再介入,而胸腔再介入与 TT 移除前的输出量之间没有关联。这些研究结果表明,在 SSRF 之后何时拔出 TT,不应该使用 TT 输出量的绝对阈值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effects of post rib plating tube thoracostomy output on the need for thoracic re-intervention: Does the volume matter?

Background: Surgical stabilization of rib fractures (SSRF) has been demonstrated to improve early clinical outcomes. Tube thoracostomy (TT) is commonly performed with SSRF, however there is a paucity of data regarding when removal of TT following SSRF should occur. This study aimed to compare patients undergoing thoracic reinterventions (reintubation, reinsertion of TT/pigtail, or video-assisted thoracic surgery) to those not following SSRF+TT, hypothesizing increased TT output prior to removal would be associated with thoracic reintervention.

Methods: We performed a single center retrospective (2018-2023) analysis of blunt trauma patients ≥ 18 years-old undergoing SSRF+TT. The primary outcome was thoracic reinterventions. Patients undergoing thoracic reintervention ((+)thoracic reinterventions) after TT removal were compared to those who did not ((-)thoracic reintervention). Secondary outcomes included TT duration and outputs prior to removal.

Results: From 133 blunt trauma patients undergoing SSRF+TT, 23 (17.3 %) required thoracic reinterventions. Both groups were of comparable age. The (+)thoracic reintervention group had an increased injury severity score (median: 29 vs. 17, p = 0.035) and TT duration (median: 4 vs. 3 days, p < 0.001) following SSRF. However, there were no differences in median TT outputs between both cohorts post-SSRF day 1 (165 mL vs. 160 mL, p = 0.88) as well as within 24 h (60 mL vs. 70 mL, p = 0.93) prior to TT removal.

Conclusion: This study demonstrated over 17 % of SSRF+TT patients required a thoracic reintervention. There was no association between thoracic reintervention and the TT output prior to removal. Future studies are needed to confirm these findings, which suggest no absolute threshold for TT output should be utilized regarding when to pull TT following SSRF.

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