创伤性气胸后水封持续时间与胸管拔除结局：一项回顾性队列研究

摘要(中文译文)

胸部创伤可能导致需要置入胸管（CT）的气胸或血胸。胸管可通过主动吸引和/或水封（WS）系统进行管理，但在安全拔管前的最佳水封持续时间仍不明确。我们评估了水封持续时间与创伤性气胸中胸管造口失败之间的关联。我们开展了一项回顾性队列研究，纳入2016年1月至2022年10月期间在一家城市一级创伤中心因创伤性气胸接受胸管造口的患者。采用两个多变量逻辑回归模型评估与水封结局（失败 vs. 成功）相关的因素。主要模型检验了单次水封（SWS）试验后水封持续时间与结局之间的关联，并对临床和人口学协变量进行了校正。次要模型使用相同的协变量评估胸管总持续时间，排除首次吸引前的时间。共有54例患者接受胸管造口；33例（61.1%）在单次水封疗程后成功拔除胸管，而21例（38.9%）在初始水封试验后需要重复吸引和/或重新置入胸管。水封持续时间与失败无显著关联（= 0.21）。较长的胸管总持续时间与失败相关，每增加12小时，比值增加39%（OR = 1.39，95% CI：1.09-1.78，= 0.008）。在这项单中心回顾性队列中，水封持续时间与胸管造口失败无显著关联，而较长的胸管总持续时间则与之相关。尽管在本队列中水封持续时间未显示与结局存在关系，但在提出持续时间建议之前仍需更大规模的前瞻性研究。

Abstract

Thoracic trauma may result in pneumothorax or hemothorax requiring chest tube (CT) insertion. CTs can be managed with active suction and/or a water-seal (WS) system, but the optimal WS duration before safe removal remains unclear. We evaluated the association between WS duration and tube thoracostomy failure in traumatic pneumothorax. We performed a retrospective cohort study of patients who underwent tube thoracostomy for traumatic pneumothorax at an urban Level 1 trauma center from January 2016 to October 2022. Two multivariable logistic regression models were used to assess factors associated with WS outcomes (failure vs. success). The primary model examined the association between WS duration and outcome after a single water-seal (SWS) trial, adjusting for clinical and demographic covariates. The secondary model evaluated total CT duration using the same covariates, excluding time to first suction. Fifty-four patients underwent tube thoracostomy; 33 (61.1%) had successful CT removal after a SWS course, whereas 21 (38.9%) required repeat suction and/or CT reinsertion after the initial WS trial. WS duration was not significantly associated with failure ( = 0.21). Longer total CT duration was associated with failure, with each additional 12-hour period increasing the odds by 39% (OR = 1.39, 95% CI: 1.09-1.78, = 0.008). In this single-center retrospective cohort, WS duration was not significantly associated with thoracostomy failure, though longer total CT duration was. While WS duration did not demonstrate a relationship with outcome in our cohort, larger prospective studies are needed before duration recommendations can be made.

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