Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter
Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter
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DOI：
10.1016/s0003-4975(99)01482-4
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发表时间：
2000-02-01
影响因子：
4.6
通讯作者：
DeFord, LL
中科院分区：
文献类型：
--
作者：
Putnam, JB;Walsh, GL;DeFord, LL
背景以往的研究表明，长期留置胸膜导管（PC）安全有效地缓解呼吸困难，维持生活质量，并减少恶性胸腔积液患者的住院治疗。与胸管和硬化剂治疗的住院患者相比，使用PC治疗恶性胸腔积液的门诊患者可以减少住院时间和早期（7天）费用。回顾性分析了1994年7月1日至1998年9月2日连续治疗的PC患者（n = 100; 60例门诊患者，40例住院患者），并与1994年1月1日至1997年12月31日连续治疗的68例住院患者进行了比较。从插入日期（第0天）到第7天获得住院费用。两组的人口统计学特征相似。168例患者中126例（75%）治疗前细胞学检查为阳性，21例（12.5%）为阴性，21例（12.5%）未知。主要组织学包括肺（n = 61，36%）、乳腺（n = 39，23%）、淋巴瘤（n = 12，7%）或其他（n = 56，34%）。中位生存期为3.4个月，治疗组间无显著差异。住院患者胸管和住院患者PC的总体中位住院时间为7.0天，而门诊患者Pleurx为0.0天。未发生与PC相关的死亡。81%（81/100）的PC患者无并发症。19例患者（19%）发生了一种或多种并发症。接受门诊PC治疗的患者（n = 60）的早期（7天）平均费用为$3，391 +/-$1，753，与住院PC（n = 40，$11，188 +/-$7，964）或住院胸管（n = 68，$7，830 +/-$4，497，SD）相比（p < 0.001）。结论：门诊胸腔积液患者应用PC治疗恶性胸腔积液安全、有效。选定的患者不需要住院。早期（7天）收费恶性胸腔积液门诊PC患者相比，住院PC患者或胸管加硬化患者减少。(C)2000年由胸外科医师协会出版。
Background. Previous studies have shown that a chronic indwelling pleural catheter (PC) safely and effectively relieved dyspnea, maintained quality of life, and reduced hospitalization in patients with malignant pleural effusions. Outpatient management of malignant pleural effusion with a PC may reduce length of stay and early (7-day) charges compared with inpatient management with chest tube and sclerosis.Methods. A retrospective review of consecutive PC patients (n = 100; 60 outpatient, 40 inpatient) were treated from July 1, 1994 to September 2, 1998 and compared with 68 consecutive inpatients treated with chest tube and sclerosis between January 1, 1994 and December 31, 1997. Hospital charges were obtained from date of insertion (day 0) through day 7.Results. Demographics were similar in both groups. Pretreatment cytology was positive in 126 of 168 patients (75%), negative in 21 (12.5%), and unknown in 21 (12.5%). Primary histology included lung (n = 61, 36%), breast (n = 39, 23%), lymphoma (n = 12, 7%), or other (n = 56, 34%). Median survival was 3.4 months and did not differ significantly between treatment groups. Overall median length of stay was 7.0 days for inpatient chest tube and inpatient PC versus 0.0 days for outpatient Pleurx. No mortality occurred related to the PC. Eighty-one percent (81/100) of PC patients had no complications. One or more complications occurred in 19 patients (19%). Patients treated with outpatient PC (n = 60) had early (7-day) mean charges of $3,391 +/- $1,753 compared with inpatient PC (n = 40, $11,188 +/- $7,964) or inpatient chest tube (n = 68, $7,830 +/- $4,497, SD) (p < 0.001).Conclusions. Outpatient PC may be used effectively and safely to treat malignant pleural effusions. Hospitalization is not required in selected patients. Early (7-day) charges for malignant pleural effusion are reduced in outpatient PC patients compared with inpatient PC patients or chest tube plus sclerosis patients.(C) 2000 by The Society of Thoracic Surgeons.