胸管切除后早期与延迟CXR的实用性
Emily H Johnson1,2, Nathan H Schmoekel1, Janet S Lee1,2
1Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA.
The American surgeon
|August 26, 2025
概括
在创伤患者摘除胸管后的胸部X射线 (ppCXR) 不管时间如何,都不会影响重复干预的发生率. 早期或延迟的ppCXR显示了类似的放射性变化和结果,质疑常规使用.
科学领域:
- 创伤手术
- 诊断成像
- 胸部医学
背景情况:
- 摘除胸管后的胸部X射线 (ppCXR) 是标准的,但其临床效用仍有争议.
- 之前的研究表明ppCXR很少改变管理,但时间对结果的影响仍然未被探索.
- 这项研究涉及早期与延迟ppCXR对创伤患者的放射性发现和临床决策的影响.
研究的目的:
- 为了比较早期 (≤4小时) 和延迟 (>4小时) 后的胸部X射线对放射变化的影响.
- 评估 ppCXR 时间对无症状创伤患者的再干预率和临床管理的影响.
- 确定ppCXR时间是否会影响X射线检测结果,或是否需要在切除胸腔管后进行进一步的干预.
主要方法:
- 在1级创伤中心 (2019-2022) 进行胸管安置和切除的无症状创伤患者的回顾性分析.
- 患者被分为早期 (≤4小时) 和延迟 (≥4小时) 的胸部X射线后组.
- 主要结局是重新干预 (CT替代,VATS,胸腔切除);次要结局包括X光学变化和停留时间.
主要成果:
- 在早期和晚期ppCXR组之间没有观察到显著的放射性变化 (26. 1% vs 29. 3%) 或重新干预率 (4. 3% vs 5. 6%).
- 通过ppCXR检测到的放射性变化具有低的灵敏度 (65. 0%) 和特异性 (73. 4%) 来预测重新干预.
- 与早期的ppCXR相比,延迟的ppCXR与非计划的ICU转移率 (5. 6%) 更高.
结论:
- 抽出胸部X射线的时间不会显著影响无症状创伤患者的放射性变化或重新干预率.
- 这些发现支持越来越多的证据质疑在该患者群体中常规使用胸部X射线.
- 需要进行更多的多中心研究,以便在创伤护理中切除胸腔管后建立标准化成像方案.
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