Risk Factors of Pneumothorax after Totally Implantable Central Venous Access Devices Placement

背景：本研究主要目的在探討癌症病患於局部麻醉下接受人工血管植入手術後氣胸之危險因子。方法：我們回溯434例接受經皮穿刺（Seldinger方法）植入人工血管患者之病歷，收集術前之相關因子及術後併發症，加以統計分析。統計方式包括描述性統計、雙變數分析、及邏輯式迴歸。結果：整體併發症機率爲5.5%。有15位病患(3.5%)術後有氣胸情形，單變數分析發現氣胸患者與無氣胸患者間之性別、年齡、身高體重指數、原發腫瘤部位、手術時間、及手術醫師並無明顯差異。唯一相關之因子爲術中無預期之咳嗽，與其他病患比較起來，在手術當中曾有無預期咳嗽之病患術後有近40倍之機會產生氣胸（勝算比：37.8, 95%信賴區間：12.0~119.0）。結論：無預期咳嗽與局部麻醉下以穿刺法進行人工血管植入手術產生氣胸有明顯相關存在。是以術前如知道患者近期有咳嗽之情形，建議於全身麻醉下進行人工血管植入手術。

關鍵字

植入性導管；氣胸；危險因子

並列摘要

BACKGROUND: This study aimed to investigate the risk factors associated with pneumothorax after placement of totally implantable central venous access device (TICVAD) under local anesthesia. METHODS: We retrospectively reviewed the medical records of 434 patients who underwent percutaneous puncture (Seldinger method) TICVAD implantation. We used descriptive statistics, univariate analyses, and logistic regression to examine relevant variables. RESULTS: The overall complications rate was 5.5%. Pneumothorax was found in 15 patients (3.5%). Univariate analyses found no statistical difference between patients with post-operative pneumothorax and those without in gender, age, body mass index, primary tumor site, side of TICVAD placement, operation duration, and the surgeon who performed the operation. The only significant factor related to pneumothorax was unexpected cough during procedure. Patients with unexpected cough during procedure had near 40-fold increased risk of pneumothorax when compared with those without (odds ratio: 37.8, 95% confidence interval: 12.0~119.0). CONCLUSIONS: Unexpected cough during procedure is strongly associated with pneumothorax after TICVAD implantation under local anesthesia. Implantation under general anesthesia is recommended for those with recent history of cough.

並列關鍵字

Implantable Catheter ； Pneumothorax ； Risk factors

國際替代計量

Risk Factors of Pneumothorax after Totally Implantable Central Venous Access Devices Placement

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