Effect Of Closed Chest Drain On Wound Closure Of Primary Spontaneous Pneumothorax

Objective 1.To explore the influence of different diameter drainage tube to primary spontaneous pneumothorax;2.To explore the influence between closed thoracic drainage time of primary spontaneous pneumothorax’ patients and the visceral pleura crevasse closed;3.To explore the different diameter drainage tube’ complications.Methods Using methods of retrospective analysis,selecting PSP patients who are in the treatment of with closed thoracic drainage in thoracic department of internal medicine Tianjin Chest Hospital(now of respiratory and critical care medicine) in January 2009- August 2014.On the basis of the drainage pipe when we implement closed thoracic drainage, the patients were divided into standard pipe group and fine catheter group;on the basis of the time from onseting to implementing closed thoracic drainage(drainage time),the patients are divided into≤1d 、 ≤3d(1d < drainage time≤3d)、≤6d(3d<drainage time≤6d)、>6d(drainage time). We use chest X-ray、analysis of chest gas and arterial blood gas results to judge whether the visceral pleura crevasse is closed. And then compare the break closure time of different diameters and different drainage tube time;the patients with different diameter drainage tube and different drainage time, who are closed thoracic drainag before the implementation drainage and become open after drainage operation; different diameter pipe drainage.The differenct complications between different diameter drainage tube after drainage operation.Results 214 patients were involved in the study in total, standard pipe group are 136 cases, fine catheter group are 78 cases.(1) In the two groups of patients,the crevasse closed time require(4.76±1.65)d and(4.54±1.67)d, there is no significant difference(t=0.963).That is mean,two groups of patients,the crevasse’s closure time has no relationship with the size of the drainage.(2)Different drainage time, crevasse’ closing time between fine catheter group and standard tube group all showed no significant differences,in the 2 groups of crevasse’ closing time, all drainage time≤6d and > 6d below the crevasse’ closing time of ≤1d and ≤3d;the crevasse’ closing time of standard tube group or fine catheter group had a negative correlation with each other(p<0.05).(3)Standard tube group,102 cases closed pneumothorax, in postoperative53 cases into open.Fine catheter group,58 cases closed pneumothorax, in postoperative 21 cases into open.Two groups of patients,who are already closed pneumothorax before closed thoracic drainage is implemented, after postoperative drainage, the incidence of reopening has no significant difference(χ2=3.691, p>0.05).(4) Different drainage time between fine catheter group and the standard tube group from closed into open were not statistically significant, in the 2 groups of proportion, all drainage time≤6d and > 6d below the proportion of ≤1d and ≤3d(χ2标=29.171,χ2细=11.722, 均 p < 0.001).(5) In the two groups of patients,the incidence of subcutaneous emphysema respectively were 12.50%(17/136) and 2.56%(2/78), the incidence of pain were 59.56%(81/136) and 3.85%(3/78). Comparison of subcutaneous emphysema or pain incidence, standard pipe group is higher than that of the fine catheter group, the difference is statistically significant(p<0.05).Conclusion Closed thoracic drainage in the treatment of PSP patients,different diameter drainage tube for the treatment of PSP, with no difference of the length of time,and no differences which lead to the closed visceral pleura open;there are differences between different drainage time and break closure time, the incidence of the visceral pleura rupture has resulted in the closed state to reopen are different the complications of standard tube group more than a fine catheter group.the complications of standard tube group more than a fine catheter group.Therefore, if the patient has no obvious breathing,circulation of clinical symptoms,delaying the implementation of closed thoracic drainage,which will conducive to break to close, reducing the effect of closed thoracic drainage surgery to the break.