| Objective: This topic mainly investigates the method by using irrigable drainage tube released by the side groove of thoracic trocar to treat empyema, compared with the method via chest wall blund dissection, and evaluates the curative effect and the security.Method:1 Clinic data: 64 examples empyema cases, 38 males and 26 females, Their ages are between 18-72 years old, and average age is 47.0±14.8 years old. Classification of empyema: acute empyema 49 examples, chronic empyema 15 examples; total empyema 38 examples, localized empyema 26 examples; diapyesis empyema 59 examples, tuberculous empyema 3 examples, and idio-pathogenicity empyema 1 example. All cases conform to empyema following standard:①confoms to empyema diagnosis standard.②has no serious lung or brain function disease or disturbance.③non-chest cavity puncture contraindication. 64 example patients were divided into two groups at random: treatment group(B group) : using irrigable drainage tube released by the side groove of thoracic trocar to treat empyema; control group(A group): inserting latex tube via chest wall blunt dissection.2 The method of inserting tube:⑴the method of inserting the thoracic trocar with the side groove and irrigable drainage tube: We set at the site according to the symptom and the chest X sternum or the CT result in the most patients, according to B hypersound at times. The site was definited the low-set in the tatal empyema, while site was definited in the locallized empyema by the B hypersound. The conventional disinfection shop turban, we anaesthetized with the 5ml injector in the point of puncture and tried on, confirming direction and the depth. After trying on successfully, we cut open the skin along the intercostal with the sharp bit. The depth reached the skin entire level, and margin long approximately 4.5-5.5mm. After the blood stopped. we could use right hand to hold of handle, along the thoracic wall vertical directiong effort, and enter the thoracic trocar. When fixing wrapper tube, we could pull out the acupuncture needle core, and drainage tube along wrapper tube was inserted into chest cavity. After definiting the drainage tube at the length in the pleural cavity, we could fix drainage tube and link the water-sealed drainage bottle, observing liquor puris drained.⑵the method of inserting the latex tube via chest wall blunt dissection: set at the position same as above, the conventional disinfection shop turban, we anaesthetized with the 5ml injector in the point of puncture and tried on, then cut open the skin and hypoderma along the intercostal with the round bit. Margin long was approximate 2-3cm, then the depth was reached to pleural cavity via chest wall blund dissection with blood vessel forceps. After inserting the latex tube into pleural cavity, we could definite the tube at the length in the pleural cavity, fix the tube and link the watet-sealed drainage bottle, observing liquor puris drained.3 The two cases were all supplied the anti-infect and nutritiong support. Keep draining the liquor puris after inserting the tube, and irrigate the pleural cavity by the latex tube and irrigable drainage tube respectively when liquor puris was not drained. Arilin 100ml and NS 100ml were infused the pleural cavity, In the end NS 100 and amikacin 0.4g were remained the vomica in total empyema, while NS 50 and amikacin 0.4g remained the vomica in localized empyema. The method was practiced once a day.4 Standard of curative effect and pulling out tube: curing: pleural effusion vanished, possibly a bit pleural thickening appear , and temperature doesn't rise as well as white blood cell; improving: pleural effusion decreased 70% after the tube inserted, temperature is nomal limits as well as white blood cell; invalid: pleural effusion remained 30% after the tube inserted, temperature rise as well as white blood cell, and they were not normal limits. Aggravation: Pleural effusion did not decrease after the tube inserted, and there was infective semptom. When liquor puris is less than 50ml in the pleural cavity and it is a little in the B hypersound too, the tube can be pulled out. Those patients were treated continuly fou a week. After 3 weeks We evaluate the curative effect, and compare A with B in the tube keeping time, T>37.3℃keeping time, and WBC>10*109/L keeping time and the complication.Results:1 Curative effect: After treating 3 weeks, The treatment group effective population is 28 examples, effective rate is 87.5%; The control group effective population is 26 examples, effective rate is 81.3%, two groups have no statistics difference (P>0.05). In the acute empyema patients, the treatment group effective population is 24 examples, effective rate is 96%; and the control group effective population is 22 examples, effective rate is 92%, there is no statistics diffenrence (P>0.05). In the chronic empyema patients, the treatment group effective population is 4 examples, effective rate is 57%; and the control group effective population is 4 examples, effective rate is 50%, there is no statistics diffenrence (P>0.05).2 The tube keeping time, T>37.3℃keeping time, and WBC>10*109/L keeping time: In the tube keeping time, the treatment group average drainage time is 9.8±3.2d, the control group: 11.3±3.4d, both has statistics difference(P<0.05). In T>37.3℃keeping time, the treatment group average T>37.3℃keeping time is 3.0±0.3d, the control group: 5.1±0.4d, two groups have statistics difference(P<0.05). In WBC>10*109/L keeping time, the treatment group average WBC>10*109/L keeping time is 3.8±0.4d, the control group: 5.3±1.0d, both has statistics difference(P<0.05). 3 Operative time: the treatment group is 8.1±2.5min, while the control group is 11.6±3.6min, there is statistics difference between two groups(P<0.05).4 The complication of operating procedure in the two sets patients: In the treatment group, 2 examples were sufferd ache, 1 example was infected around tube, 1 example was subcutaneous emphysema, 1 example was tube blocking, and 1 example was the drainage tube falling off, while 3 examples, 1 example, 2 examples, 1 example, 2 examples in the control group respectively, two groups have no statistics difference (P>0.05). The treatment group has no blood in the tube inserted process, while the control group has 6 examples blood(>5ml), there is statistics difference (P<0.05).5 Life symptom and saturation of pulse oxygen change: before the tube was placed, the patients'heart rate and the breath frequency are higher than patients' one hours after the operation in the two sets patients respectively, they have statistics diffenrence(P<0.05). In front of and one hour later operation, the patient's blood-pressure and the saruration of pulse oxygen didn't change obviously in two groups, non-statistics significances(P>0.05).Conclusion:This research shows that the method of inserting the irrigable drainage released by the side of thoracic trocar to treat empyema is the same as the method via chest wall blunt dissection, and the two methods are all well effective in treating acute empyema. This method is simple in puncture progress, keep the tube time no long, has short operative time, easy by irrigating vomica, only little complication of operation and so on. There is not unhealth effective obviously to patient's life symptom. The skill is easy practice, and has the broad clinical practice prospect. |
PDF Full Text Request