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Application of Digital Thoogenesis System in Pulmonary Bronchial pleural fistula treatment

1. Preface

Bronchial pleural fistula (BPF, Bronchopleural fistula) refers to a fistula formed between the alveoli, the bronchial and pleural cavity. In recent years, although pulmonary resection surgery has improved and improved, the broncho pleural fistula (BPF, Bronchopleural Fistula) is still serious complications that may occur after pulmonary resection. The literature reported that the incidence of BPF was 1.5% to 12.5% ​​in full pulmonary resection, and the incidence rate was 0.5% to 3% after pulmonary leaf removal. The relevant risk factors included bronchial residual tumors, and the residue was too long. , Diabetes, steroids, new auxiliary chemotherapy or radiotherapy, infection, etc. According to reports, the related mortality rate is high, up to 71% [2]. The correct treatment is the most important after diagnosis. Although the death rate is high, it is undeniable that BPF has self-healing, although it is just a report. In recent years, with the continuous development of science and technology, the drainage system is also constantly improving. The new type of digital chest drainage system can greatly compensate for the low pressure level, unstable and insufficient convenience of traditional drainage bottles, with negative pressure adjustable, digital, visualization, full monitoring, easy to carry and real-time monitoring pipes. The advantages of smooth, close, etc., there is currently a literature report and clinical guidance to confirm that digital drainage systems can be applied to the treatment of continuously refractory leakage after pulmonary surgery [3], this study group is for the above situation, using digital drainage systems Oversized negative pressure suction value (50 cm h 2 o water column pressure), visualization chart and quantitative detection recording function [4] The initial results will be reported as follows.

2. Materials and Methods

2. The subject

30 patients with pneumatic pleural fistula.

2.2. Selection of cases and treatment

This is a retrospective and descriptive study. The Affiliated Hospital of Qingdao University has a total of 30 patients from 1 to 2022, 2012. There are 18 cases of traditional groups, which use conventional chest closing drainage, drainage liquid ≤ 150 ml / d, and gas-free . Digital group 12 cases application DDS conduct drainage treatment, the age, gender, resection of lungs in 2 groups, pathological types, etc. have no statistical significance, see

Table 1

. All patients were diagnosed with bronchi pleural fistula under tracheir mirror or chest CT examination. The visibility of the imaging, and the fistula can directly find the fistula residual cavity, visible liquid plane, which is a new month and can be seen. The residual fistula, chest closed drainage leaks. The bronchial pleural fistula should be focused on the as early as possible, which has been reported that the endoscopic sealing fistula has shown the exact effect under the fistula having less than 5 mm, but the presence is poorly compatible with human tissue, and easy to fall off. Risks, especially those with infection [5]. Some patients have passed gas mirror inspection, endoscopic lavage treatment, and poor body state, ECOG score 3 points, secondary surgical risk is high, no surgery. Our experience and conservative treatment, after communicating with patients and their families, signed an informed consent, and select closed drainage conservative treatment.

Table 1 . The General Data of The Two Groups WERE Compared

. Two groups of patients general data comparison 2.3. Digital drainage device use and treatment flow

Chest drain tube and Thopaz Digital Thoracic closed drainage system (Medele Medela, Switzerland), digital drainage system device has functions that record patient numbers, adjust and record attractive negative pressure, drainage speed, while the drainage is full, system leaks, system blocking, drainage A alarm feedback can be issued when the filter is blocked and the system is exhausted. Set a negative pressure pressure -15 cm H

2 O. At the same time, the patient has the above conventional chest closure drainage care. During the system, the alarm prompt of the system is replaced, the drainage tube, etc., according to the digital curve of the system record and determine the leakage of the patient, electronic recording, drainage, air pressure, leakage velocity, etc. index. According to ESTS, AATS in 2011STS, GTSC published a joint guide for chest management [6], we set DDS negative pressure values ​​to -15 ~ 20 cm H 2

O, set the tube indicate to the discharge liquid ≤ 300 ml / d, and / or the amount of air leak ≤ 20 mL / h, lasting 8 h. When ensuring good chest tube, adjust the negative pressure to the maximum value of patient tolerance, early sufficient drainage, according to the patient’s comfort. Adjustment. It is ensured that providing a stable negative pressure value in the chest, and the degree of lung resequence determines the timing of the pleural fixation. If the patient is subjected to an obvious gemosphere or apermatoma, it is necessary to observe the absorption of vaporization while determining the drainage. For uncertainty, whether the lungs and chest wall bonders are selected, according to the patient’s condition, the chest CT is selected, and after the exact position of the chest drainage tube is observed, the negative pressure parameters are adjusted in time according to the drainage effect, early lungs Good compliance, after the digital drainage is negatively attracted, the lung part is rejected, the lung tissue is attached, the cavity is reduced, and the cavity is separated, limited to the purpose of eliminating the cavity. Observe the patient’s vital signs, drainage flow, drainage volume and color, observe the reasons in the chest and the changes in the residual cavity, and adjust the position of the tube position and the inception of the chest in time according to the drainage condition. When the patient’s 24-hour flow is less than 2,000 ml / min, the drainage volume is less than 400 mL, the drainage is clear, yellowish yellow, no infection, the negative pressure is adjusted to -8 ~ 12 cm h

2

O, continue Conservative treatment for a while. Observing the patient’s vital signs, the drainage flow is less than 40 ml / min [7], even the interruption has no air leaks, the drainage liquid is less than 100 mL, the drainage is clear, yellowish yellow, first adjust the depth, to the body surface Drainage tube. When the lungs in the chest are well, there is no residual empty hole, there is no obvious air leak when there is no obvious effusion, and there is no obvious leakage when coughing, and the chest drainage tube is removed.

2.4. Observation Index and Analysis

Collect all cases related clinical data. Dynamically observe the size of the lumen in the chest and the flow rate of digital drainage devices and the changes of drainage fluids. Compare the air leakage time, tube time, hospitalization time, etc. in the two groups. 2.5. Statistical treatment Application statistics software (SPSS 26.0Method software) line data analysis description. The quantitative data of normal distribution takes independent sample T test, the qualitative data is tested by χ 2 , the inspection level D = 0.05, P

3. Result

3.1. General Situation

30 patients with delayed bronchone pleura fistula were successfully treated by conservative drainage. The white blood cells have decreased significantly, and the body temperature returns to normal. Correct low-proteinummia, the pleural effusion gas is completely discharged, the residual cavity disappears, confirmed under the tracheoscope, and the broncho pleural fistula is completely healing. Follow-up for these cases, currently recovered, and the residual lungs completely recovered, no bronchi pleural fistula recurring.

3.2. Observation Indicators

See Table 2 < 0.05为差异有统计学意义。

, digital group chest drainage time, recovery time and hospital stay are shorter than traditional groups. Tube drainage time [34.00 ± 6.700 Vs 57.83 ± 8.313, P = 0.049], healed [36.33 ± 7.025 VS 61.33 ± 8.507, P = 0.045], hospitalization time [33.25 ± 5.619 vs 49.06 ± 5.030, P = 0.048].

Table 2

. Observation Indexes of the Two Groups Were Compared Table 2

. 2 sets of observation indicators Comparative

3.3. Drug applications and nursing experience 1) Respiratory management: give atomization, mechanical assistance Early periodically, early encouragement and assist patient cough and deep breathing, so that the pleural cavity gas and liquid are discharged, enabling the lungs, eliminating the residual cavity, preventing excessive accumulation of excess and induces bronchial pleural fistula. Infection. For patients with weak weakness and sputum viscous, the active bronchoscopic lens is active to ensure the drainage of the chest closed drainage tube. 2) Nutrition support: patients with thoracic surgery due to bleeding, seepage, infection(Puzzle) and other reasons cause a large amount of protein, which is easy to distinguish an anastomosis, affecting healing. Postoperative guidance patients eat high-protein diet that can eat nutrients. For patients with exudation, intravenous support, infusion of plasma, albumin, etc., improve the nutritional status of the patient. 3) Anti-infective treatment: According to the color of the drain liquid and the nature combined with pleural effusion, the antibiotic is adjusted in time, and some long-term strap patients cultivate bacteria, fungi, and pass through antibacterial therapy, complete control. 4) Appropriate psychological counseling to help improve patients’ bad mood and emotions.

4. Discussion

Bronchial pleural fistula is a severe complication after pulmonary resection. According to the time limit of the occurrence, the habit of dividing BPF is early ( 30 days) [8]. Early fistile is more surgical techniques; if the mid-term fistula is not a missed diagnosis, it is more related to systemic factors. Due to the absence of bronchial pleural fistula, the drainage is not smooth, infection cannot be effectively controlled, and the postoperative bronchial pleural fistula and the refractory persistence of the refractory persistence have many adverse effects on the patient, mainly to increase the risk of other complications, extended Draw time and hospital stay, this undoubtedly also increases the patient’s spirit and economic burden. The principle of treatment is to control infection, drain the pleural effusion, and promote lung function recovery. Fully drain is the most basic conservative treatment. Most published papers involve endoscopy and surgical treatment. Summary experience and conservative treatment, reference digital drainage devices. The traditional drainage system is typically composed of a chest drainage tube and a water seal bottle, and a negative pressure of 16 cm H 2 O, but this drainage device is limited to postoperative patient activity [9] [10 ] At the same time, it also produces a large noise affecting the patient’s rest due to bubbles in the water seal bottle. For a large amount of long-lasting and lung failure after surgery, it is clinically used to encourage cough and blow bar to promote the pulmonary inflation, and create conditions for subsequent pleural effusion; or wait for a chest The method of fixed cavity is reached with the tubing conditions. However, the above methods have a shortcomibility of time consumption, and the patient’s quality of life is seriously limited. With the development of science and technology, drainage systems are constantly improving. Digital drainage devices are not subject to physical level, convenient placement, easy to observe and operate data, light weight, easy to carry liquidity, promote wound healing, and speed up the bed turnover [11]. RememberAccurately, eliminate the differences in subjective judgment, unified doctors, nurses, and even the record standards of patients, adjustments according to the recording results. The traditional drain bottle water seal bottle should be lower than the drainage tube, prevent the retrograde infection, keep the drainage tube, properly solve, prevent accidental prolapse, need to place the rough tube, the patient is obvious, can not lie down, water seal bottle needs regular Replacement, negative pressure must be provided by the bed, negative pressure is unstable, and greatly affects the position of the body affects the body, the relevant care step is complex, the drainage is treated, and the pollution is high. Digital drainage systems are safer, more efficient, more comfortable, more accurate, and more convenient. Compare the traditional water seal via, the specific advantages are as follows: 1) Digital drainage system has an automatic flushing function, which is not easy to block the pipe, there is an automatic alarm function. Easy to carry, disposable sterile packaging, drainage bottle devices and unique enclosures, easy to close, easy to use. 2) Negative pressure self-sufficiency, adjustable, drainage, and accelerate lung function recovery. Continuous negative pressure attracts the smoothness of the drainage, continuous and accurate negative pressure attraction: continuous negative pressure plays a key role in improving the exclusion of thoracic fluid gas, which is conducive to the expansion of postoperative lungs, eliminating After the increase in the negative pressure in the chest, the key unfavorable factors increased by the extension, such as the increasing drainage is insufficient, and the thin tube can be placed in the second rib between the clavicle centerline and can be connected to the Y-type joint tube. In addition, avoid fluctuations in chest pressure, avoid frequent airflow through fistula, chest gas is an important factor that causes lungs, and the greater the fluctuations of chest pressure, the longer the bronchial and lung wounds. The DDS system maintains accurate negative pressure levels, thoroughly improving the fluctuation of chest pressure, so it is conducive to reducing the leakage of lung wounds, promoting the wounds and toromers. The adjustable negative pressure is close to the target negative pressure, ensuring the integral controlled, real-time data, facilitating observation and tube consensus and guidelines based on digital controllability and objectivity. 3) The digitization group can be placed on the back of 12F, reducing pain, affecting the patient, can lie down, protect good rest sleep, affected by the body position, can be normal, patient after surgery, patient after surgery Gradually normalization, traditional water seal bottles do not meet the patient while underlying activities, the continuous negative pressure attraction is guaranteed; the installation is convenient, reducing the workload of nursing staff, reducing the replacement of the drainage [12] [13]. 4) Nursing during the treatment of traditional chest closed drainagePersonnel will squeeze the drainage tube, check whether the pipe is blocked, but during the extrusion process, the pain can cause positive pressure because of pain, cough, the sink, so that the liquid flowing out is filling the chest, Causes the occurrence of complications such as infection. DDS belongs to an adjustable attraction, an active drainage system, which reduces the risk of infection to a certain extent.

After 12 patients applied digital drainage devices, the drainage was smooth, infected, the residual cavity disappeared, the leakage volume was reduced, and the fistula was smaller. Basic cure within 1 to 2 months. Observe the patient’s vital signs, drainage flow, drainage volume and color. According to the condition, it is required to regularly review the chest CT to observe the changes in the residual cavity in the chest. The residual lungs, reverse, deformation, and fitting, eliminating residual cavity and acceleration healing. As a result, the total time of the digital drainage device to treat bronchial pleura fistula is 36.33 ± 7.025 d, and the treatment time (3 to 6 months or even longer time) is significantly shortened than those of the literature. The application of digitized drainage devices can be discharged from hospital and do not have to stay in hospital. Perform regular follow-up examination, no bronchial pleural fistula recurrence. Patients with bronchial pleural fistula occurred after 12 patients of the digitization of the digitization, and achieve extubation and discharge in the time of the average treatment cycle after negative pressure induced by the DDS, to reduce the economic burden and spiritual burden for patients. Since the broncho pleural fistula is a rare complication after pulmonary surgery, the total number of patients with broncho pleural fistula is less, and the past documents and clinical empirical demonstrates their feasibility and superiority. According to the data contrast and total drainage days before and after using DDS drainage The relevant information can still reflect the advantages of DDS active high negative pressure suction drainage systems in such cases. Combined with existing DDS and conventional drainage method for randomized controlling clinical study of broncho pleural fistula (

), digital group cranked rate reached 100%, we have more adequate evidence to use DDS The drainage of patients with bronchone pleura fistula is a clinical reference value. Chen Yuxi [12] reported that the use of digital drainage devices for the treatment of pulmonary persistence, and has also achieved good clinical efficacy, indicating that digital pleural drainage systems are used for the treatment of post-delayed broncho pleural fistula after pulmonary surgery, Accelerated bronchial pleural fistula patients rehabilitation discharge.

Table 3

. Comparison of Curative Effect Between Digital System and Traditional Conservation Drainage In Patients with Bronchopleural Fistula

Table 3 . Conditions in therapeutic mode of digital system and traditional conservative drainage in patients with broncho pleural fistula

NA: NOT AVAILABLE (Description: 2 cases of traditional groups in our school have neared, long-term belongings Regular drug transfer; 1 patient was died due to tumor recurrence, not included in Table 1 ,

Table 2

analysis).

Conservative treatment of bronchial pleural fistula after pulmonary leaf removal is a safe and effective method, and another feasible treatment in terms of endoscopy, surgical surgery. method. Digital pleural drainage system is used for safety after pulmonary delayed broncho pleural fistula, providing a greater and more sustained negative pressure attraction value, thereby promoting lung replenishment, smooth drainage, avoiding infection, and shortening the number of drainage days and hospital stay. In summary, the accelerated rehabilitation of patients with delayed bronchial pleural fistula after thoracic mirror has a positive significance. DDS is a safe, minimally invasive, effective, visualized treatment for the treatment of BPF, which is worth further promotion.

Notes

* Corresponding author.

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