Application Research On Enhance Recovery Of The Use Of A Single Chest Drain After The Open Lung Upper Lobe Carcinoma Radical Excision

Objectivs: By observing the clinical indicators and complications in the immediate postoperative course between the use of a single or double chest drain after the open lung upper lobe carcinoma radical excision. Discuss the application of the use of single chest tube drainage in patients after the open lung upper lobe carcinoma radical excision in fast track surgery.Methods: 160 cases of consecutive patients undergone traditional thoracotomy upper lobectomy by the second operation team from February 2015 to December 2016 in Thoracic surgery of Yunnan Tumor Hospital were enrolled and do a prospective cohort study.Patients were classified into 2 groups according to different drainage methods: Group A include 80 patients using single chest drainage and Group B include 80 patients using double chest drainage. Observe and record the different drainage method with duration of chest tube drainage, the amount of drainage,hospital stay, first 7 days postoperative VAS scores and the incidence of postoperative complications,compare of the differences between the two groups.Results: A total of 80 patients using single chest drain and 80 patients using double chest drain.Both groups were similar in age,gender,laterality,recection specimens,histology,pathological evaluation and lung function text. There was no statistical difference in drainage duration(P>0.05).There was significantly lower amount of drainage in the group A compared with the group B [(579 ±66.38) vs (867±117.00),P<0.05].Postoperative length of stay was shorter in the group A than in the group B[(7.13±1.46) vs (9.05±1.46),P< 0.05],the leaving bed time in group A is sooner than in group B[(3.29±0.845) vs (3.61±0.584),P<0.05].There were no significant differences of mean VAS among group A and B in the first two days and the last day postoperatively[(5.41±0.852) vs (5.73±1.158),P=0.054;(4.66±0.779) vs(4.78±0.927),P=0.470; (2.25±0.464) vs (2.38±0.644),P=0.161],Group B patients had a significantly higher maximum pain score compared with group A in the 3rd day to the 7th day postoperatively [(3.39±0.771) vs (4.55±0.980),/P=0.000;(3.31±0.836) vs(3.88±0.817),P=0.000;(3.14±0.443) vs (3.31±0.493),P=.019;(2.661±0.635) vs(2.91±0.660),=0.016) ; (2.25±0.464) vs (2.58±0.652),P=0.000].There were no statistically significant difference was found between the two groups postoperative complications including arrhythmia(13.75% vs 16.25%,P=0.658),residual pneumothoraces (6.25% vs 2.5%,P=0.344),atelectasis(5.00% vs 3.75%,P--0.699),pulmonary infection(8.75% vs 10%,P=0.786),drainage wound infection(1.25% vs 2.5%,P=1),subcutaneous emphysema (6.25% vs 2.50%;P=0.246).There were no statistically significant difference was found between the two groups in the number of addition chest tube(2.5% vs 3.75%,P=.0650).Conclusions: A single chest drain is just as effective,less painful,lower amount of drainage,shorter postoperative length of stay,and the operation is simple than the conventional use of two drains after traditional thoracotomy pulmonary lobectomy.It's convient to patients to activity earlier.Did not increase the risk of postoperative complications.Early to improve the comprehensive state of the patients and achieve the goal of fast rehabilitation.