اﺛﺮ ﺑﺨﺸﯽ ﺗﻌﺪاد ﻟﻮﻟﻪ ﺳﯿﻨﻪاي و ﻧﺤﻮه ﺧﺎرج ﮐﺮدن آن ﭘﺲ از ﺗﻮراﮐﻮﺗﻮﻣﯽ

Effectiveness of the Number of Chest Tubes and how to Remove it after Thoracic Surgery

ﺟﻬﺖ درﻧﺎژ ﻫﻮا و ﻣﺎﯾﻊ ﺗﻌﺒﯿﻪ ﻣﯽﺷﻮد. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﮔﺴﺘﺮش ﺟﺮاﺣﯽ ﺗﻮراﮐﺲ و ﭘﯿﺸﺮﻓﺖﻫﺎي ﺣﺎﺻﻠﻪ ﺿﺮورت ﺗﻌﺒﯿﻪ دو ﻟﻮﻟﻪ ﺳﯿﻨﻪاي و ﻣﻘﺎﯾﺴﻪ آن ﺑﺎ ﺗﻌﺒﯿﻪ ﺗﻨﻬﺎ ﯾﮏ ﻟﻮﻟﻪ ﺑﺮرﺳﯽ ﺷـﺪه و ﻫﻤﭽﻨﯿﻦ ﺑﻪ ﻣﻘﺎﯾﺴﻪ ﺧﺎرج ﮐﺮدن ﻟﻮﻟﻪ ﺳﯿﻨﻪاي در دم ﻋﻤﯿـﻖ ﺑﺎ ﺑﺎزدم ﻋﻤﯿﻖ ﭘﺮداﺧﺘﻪ ﺧﻮاﻫﺪ ﺷﺪ. ﻣﻮاد و روش ﻫﺎ: ﺗﻌﺪاد 43 ﺑﯿﻤﺎر ﻣﺮاﺟﻌﻪ ﮐﻨﻨﺪه ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎنﻫﺎي ارﺗﺶ ﻃﯽ ﺳﺎلﻫﺎي 95 ﺗﺎ 97 ﮐﻪ ﻣﻮرد ﺗﻮراﮐﻮﺗﻮﻣﯽ ﻗﺮار ﮔﻔﺘﻪ ﺑﻮدﻧﺪ ﺑﻪ ﺻﻮرت راﻧﺪوم ﻣﻮرد ﺗﻌﺒﯿﻪ ﯾﮏ ﻟﻮﻟﻪ ﺳﯿﻨﻪاي و ﯾﺎ دو ﻟﻮﻟﻪ ﺳﯿﻨﻪاي ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﻣﺪت زﻣﺎن ﺑﺴﺘﺮي، ﻣﯿﺰان درد و اﻓﯿﻮژن ﻣﺠﺪد ﻣﺎﯾﻊ ﭘﺲ از ﺗﺮﺧﯿﺺ ﻣﻮرد ارزﯾﺎﺑﯽ ﻗﺮار ﮔﺮﻓﺖ. ﻫﻤﭽﻨﯿﻦ ﺧﺎرج ﮐﺮدن ﻟﻮﻟﻪ ﺳﯿﻨﻪاي در 22 ﺑﯿﻤﺎر در ﺣﺎﻟﺖ دم ﻋﻤﯿﻖ اﻧﺠﺎم ﺷﺪه و 21 ﺑﯿﻤﺎر ﺑﻌﺪي در ﺣﺎﻟﺖ ﺑﺎزدم ﻋﻤﯿﻖ ﺻﻮرت ﮔﺮﻓﺖ. ﯾﺎﻓﺘﻪ ﻫﺎ: 43 ﺑﯿﻤﺎر ﺑﺎ ﻣﺤﺪوده ﺳﻨﯽ 14 ﺗﺎ 72 ﺳﺎل ﮐﻪ ﺷﺎﻣﻞ 27 )63 درﺻﺪ( ﻣﺮد و 16 )27 درﺻﺪ( زن ﺑﻮدﻧﺪ، وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪ. اﻋﻤﺎل ﺟﺮاﺣﯽ ﺷﺎﻣﻞ 21 ﻣﻮرد دﮐﻮرﺗﯿﮑﺎﺳﯿﻮن، 14 ﻣﻮرد ﮐﯿﺴﺖ ﻫﯿﺪاﺗﯿﺪ، 3 ﻣﻮرد ﻟﻮﺑﮑﺘﻮﻣﯽ و 5 ﻣﻮرد ﭘﻨﻮﻣﻮﺗﻮراﮐﺲ ﺧﻮدﺑﺨﻮدي ﺑﻮدﻧﺪ. ﺑﺮاي ﺑﯿﻤﺎران ﺑﻪ ﺻﻮرت ﯾﮏ در ﻣﯿﺎن 2 ﻟﻮﻟﻪ ﺳﯿﻨﻪاي و ﯾﺎ ﯾﮏ ﻟﻮﻟﻪ ﺗﻌﺒﯿﻪ ﺷﺪ. ﻣﯿﺰان درد و ﻣﺪت زﻣﺎن ﺑﺴﺘﺮي در ﮔﺮوه داري ﯾﮏ ﻟﻮﻟﻪ ﺳﯿﻨﻪاي و ﻫﻤﭽﻨﯿﻦ رﺿﺎﯾﺖ ﺑﯿﻤﺎر ﺑﻪ ﺻﻮرت ﻣﻌﻨﯽداري ﮐﻤﺘﺮ ﺑﻮد )0/005 < P(. ﻣﯿﺰان ﺗﺠﻤﻊ ﻣﺠﺪد ﻣﺎﯾﻊ در ﮔﺮوه داراي ﯾﮏ ﻟﻮﻟﻪ ﻣﺨﺘﺼﺮ ﺑﯿﺸﺘﺮ ﺑﻮده )7 ﺑﻪ 4 ﻧﻔﺮ( وﻟﯽ ﻣﻌﻨﯽدار ﻧﺒﻮد )0/050 = P(. ﺧﺎرج ﮐﺮدن ﻟﻮﻟﻪ ﺳﯿﻨﻪاي در ﺣﺎﻟﺖ دم ﻋﻤﯿﻖ و ﯾﺎ ﺑﺎزدم ﻋﻤﯿﻖ در ﺻﻮرﺗﯿﮑﻪ ﻣﺎﻧﻮر واﻟﺴﺎﻟﻮا ﺑﻪ ﺧﻮﺑﯽ اﻧﺠﺎم ﺷﻮد، ﺗﻔﺎوﺗﯽ در ﻟﯿﮏ ﻫﻮا ﻧﺪاﺷﺖ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺗﻌـﺒﯿﻪ ﯾﮏ ﻟﻮﻟﻪ ﺳﯿﻨﻪاي ﻣﻨﺠـﺮ ﺑﻪ ﮐﺎﻫـﺶ ﻫـﺰﯾﻨﻪ و ﻣﺪت زﻣﺎن ﺑﺴﺘﺮي ﺑﻮده و ﻓﻌﺎﻟﯿﺖ ﺑﯿﻤﺎر ﭘﺲ از ﺟـﺮاﺣﯽ را ﺑﻬﺒﻮد ﻣﯽﺑﺨﺸـﺪ، وﻟﯽ ﻻزم اﺳـﺖ اﯾﻦ ﻣﻄﺎﻟﻌـﻪ در ﮔـﺮوه ﺑﺰرﮔﺘﺮ و ﮔـﺮوهﻫﺎي ﺑﯿﻤﺎري ﻃﺒﻘﻪﺑﻨﺪي ﺷﺪه ﻣﻮرد ارزﯾﺎﺑﯽ ﻗﺮار ﺑﮕﯿﺮد.

Introduction & Objective: At present, based on reference books, at the end of the more thoracic surgeries, two chest tubes are inserted in the anterior and the poster for drainage of air and fluid. Considering the development of thoracic surgery and the advances made, the need to insert two chest tubes and compare it with the embedding of just one tube and also compare the removal of the chest tube in a deep inspiration with deep exhalation will be considered. Materials & Methods: A total of 43 patients referred to the Army Hospitals during the years 95 to 97 who were referred to thoracotomy were randomly assigned a chest tube or two chest tubes. The duration of hospitalization, the amount of pain and re-effusion of fluid after discharge were evaluated. Chest tube removal was done in 22 patients with deep inspiration and 21 patients were in deep expiration. Results: 43 patients aged between 14 and 72 years old, including 27 males and 16 females, were enrolled in the study. Surgery included 21 cases of decortication, 14 cases of hydatid cyst, 3 cases of lobectomy and 5 cases of spontaneous pneumothorax. The amount of pain and duration of hospitalization and patient satisfaction in the group of one chest tube were significantly lower (P < 0.005). The amount of fluid re-accumulation in the group with one chest tube was little more (7 to 4), but not significant (P = 0.05). Taking off chest tube in deep inspiration or expiration if the Valsalva maneuver is done well, there is no difference in the air's lick. Conclusions: The insertion of only one chest tube leads to a reduction in the cost and duration of hospitalization and improves the patient's postoperative activity, but it is necessary for this study to be evaluated in the larger matched group.