Analysis of influencing factors for postoperative thoracic drainage duration in patients with cavitary pulmonary tuberculosis and clinical nursing strategies_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Jun ¹ , WANG Ning ¹ , YUAN Ye ¹ , SHU Huiyu ² , LIU Xiaojuan ¹ , YE Zaoli ¹ , BAI Qiuling ¹ , JIANG Liangshuang ¹ ,  YAO Xiaojun ¹

1. Department of Thoracic Surgery, Public Health Clinical Center of Chengdu, Chengdu, 610061, P. R. China;
2. School of Public Health, Chengdu Medical College, Chengdu, 610500, P. R. China;

Corresponding?author：

YAO Xiaojun, Email: flyingyao@163.com

Keywords：

Cavitary tuberculosis; surgery; clinical care; thoracic drainage duration; influencing factors

DOI：

10.7507/1007-4848.202506003

Video：

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Objective To analyze the influencing factors for postoperative thoracic drainage duration in patients with cavitary pulmonary tuberculosis and clinical nursing strategies. Methods A retrospective analysis was conducted on the clinical data of patients with cavitary pulmonary tuberculosis who underwent surgical treatment in the Department of Thoracic Surgery at Public Health Clinical Center of Chengdu from December 2022 to December 2024. Patients with a drainage time ≤7 days were included in the recovery group, while those with a drainage time >7 days were included in the control group. Data on patients' preoperative Hamilton anxiety and depression scores, perioperative nursing conditions were collected, and factors affecting chest drainage time were analyzed. Results A total of 186 patients were included in this study, including 119 males and 67 females, with an average age of (36.10±15.20) years. The average chest drainage tube retention time was (10.59±9.24) days. Preoperative Hamilton anxiety and depression assessments showed that 47.31% (88/186) of patients were anxious, and 31.72% (59/186) were depressed. Multivariate analysis indicated that having a smoking history, undergoing open-chest surgery, prolonged postoperative use of analgesic pumps, preoperative anxiety, and depression were independent risk factors for chest drainage time >7 days (P<0.05); frequent coughing and longer average daily activity time postoperatively were protective factors for chest drainage time >7 days (P<0.05). Conclusion Patients undergoing surgery for pulmonary tuberculosis often experience anxiety and depression preoperatively. In the clinical nursing of patients with cavitary pulmonary tuberculosis, efforts should be made preoperatively to help patients adjust their anxious and depressed emotions, control smoking, and prefer minimally invasive surgery; postoperatively, reducing analgesic duration, increasing cough frequency, promoting effective coughing, and extending average daily activity time can effectively shorten the postoperative chest drainage time, facilitating the rapid recovery of patients after surgery for pulmonary tuberculosis.

1.	World Health Organization. Global tuberculosis report 2024. Geneva: World Health Organization, 2024.
2.	World Health Organization Regional Office for Europe. The role of surgery in the treatment of pulmonary TB and multidrug- and extensively drug-resistant TB. World Health Organization, 2014.
3.	Zaleskis R, Mariani AW, Inzirillo F, et al. The role of surgery in tuberculosis management: indications and contraindications. In: Migliori GB, Raviglione MC, eds. Essential Tuberculosis. Cham: Springer International Publishing, 2021: 141-148.
4.	中華醫學會結核病學分會. 中國耐多藥和利福平耐藥肺結核外科治療專家共識 (2022年版). 中華結核和呼吸雜志, 2023, 46(2): 111-120.Chinese Society for Tuberculosis, Chinese Medical Association. Expert consensus on surgical treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis in China (2022 edition). Chin J Tuberc Respir Dis, 2023, 46(2): 111-120.
5.	張法旺, 李森, 于新輝, 等. 不同切口手術聯合加速康復外科理念指導下的呼吸功能訓練在肺癌患者中的應用效果. 中國臨床醫學, 2024, 31(5): 778-782.Zhang FW, Li S, Yu XH, et al. Application effect of different incision surgeries combined with respiratory function exercise under the guidance of enhanced recovery after surgery concept in patients with lung cancer. Chin J Clin Med, 2024, 31(5): 778-782.
6.	劉穎. 個案管理的延伸護理服務對肺結核患者術后遵醫行為及生活質量的影響. 中國醫藥指南, 2020, 18(32): 225-226.Liu Y. Effect of extended nursing service of case management on post-operative compliance behavior and quality of life of patients with tuberculosis. Guide China Med, 2020, 18(32): 225-226.
7.	劉靜, 張娜. 個體化圍手術期護理在行肺切除術的肺結核病患者中的應用效果. 臨床醫學研究與實踐, 2020, 5(7): 156-158.Liu J, Zhang N. Application effect of individualized perioperative nursing on patients with pulmonary tuberculosis undergoing pneumonectomy. Clin Res Pract, 2020, 5(7): 156-158.
8.	中華人民共和國國家衛生和計劃生育委員會. WS 288—2017 肺結核診斷. 結核與肺部疾病雜志, 2024, 5(4): 376-378.National Health and Family Planning Commission of the People's Republic of China. WS 288—2017 diagnosis of tuberculosis. J Tuberc Lung Dis, 2024, 5(4): 376-378.
9.	朱云柯, 林琳, 廖虎, 等. 中國胸外科圍手術期疼痛管理專家共識(2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.Zhu YK, Lin L, Liao H, et al. Expert consensus on perioperative pain management in thoracic surgery in China (2018 edition). Chin J Clin Thorac Cardiovasc Surg, 2018, 25(11): 921-928.
10.	中國醫師協會胸外科醫師分會, 等. 胸部手術圍術期持續性肺漏氣管理策略全國專家共識(2023). 中華胸心血管外科雜志, 2024, 40(4): 193-200.Chinese Medical Doctor Association Thoracic Surgeon Branch, et al. Management strategies for persistent pulmonary air leak in the perioperative period of thoracic surgery: national expert consensus (2023). Chin J Thorac Cardiovasc Surg, 2024, 40(4): 193-200.
11.	張春曉, 趙世娣, 周靜怡. ABCD護理分級與主動氣道加溫濕化干預結合對急性肺炎病人癥狀改善效果及HAD評分的影響. 全科護理, 2021, 19(36): 5130-5133.Zhang CX, Zhao SD, Zhou JY. Effect of ABCD nursing grading combined with active airway warming and humidification intervention on symptom improvement effect and HAD score in patients with acute pneumonia. Chin Gen Pract Nurs, 2021, 19(36): 5130-5133.
12.	張露露, 王喜玲, 馬東波, 等. 肺結節對患者焦慮、抑郁評分的影響. 河南醫學研究, 2023, 32(6): 1009-1012.Zhang LL, Wang XL, Ma DB, et al. Influence of pulmonary nodules on anxiety and depression scores of patients. Henan Med Res, 2023, 32(6): 1009-1012.
13.	Lu Y, Wang H, Zhu J, et al. Effect of targeted nursing intervention plus psychological counseling on quality of life, negative emotions, and complications in patients with extensively drug-resistant tuberculosis. Am J Transl Res, 2021, 13(12): 13950-13958.
14.	Yuan W, Chai L, Wang J, et al. Integrated nursing and psychological intervention for tuberculosis complicated by lung cancer: clinical efficacy. Altern Ther Health Med, 2024.
15.	柳英, 盧森, 項玲, 等. 基于循證理念的康復護理對肺部手術患者的應用效果分析. 中國社區醫師, 2022, 38(32): 128-130.Liu Y, Lu S, Xiang L, et al. Analysis of application effect of evidence-based rehabilitation nursing in patients with lung surgery. Chin Community Dr, 2022, 38(32): 128-130.
16.	徐磊. 肺結核肺葉切除術后聯合胸腔負壓吸引治療的療效分析. 吉林醫學, 2018, 39(4): 739-741.Xu L. Analysis of the efficacy of combined negative pressure suction therapy of the chest after lobectomy for pulmonary tuberculosis. Jilin Med J, 2018, 39(4): 739-741.
17.	馬龍, 李德生, 張力為, 等. 負壓吸引對肺手術后康復效果的Meta分析. 中國醫藥科學, 2021, 11(7): 40-46.Ma L, Li DS, Zhang LW, et al. Meta-analysis of the efficacy of negative pressure suction on rehabilitation after lung surgery. China Med Pharm, 2021, 11(7): 40-46.
18.	黃歡. 肺術后漏氣患者應用負壓吸引引流的療效分析. 南昌: 南昌大學, 2024.Huang H. The efficacy analysis of negative pressure suction in patients with postoperative air leakage after lung surgery. Nanchang: Nanchang University, 2024.
19.	Koryllos A, Eggeling S, Schega O, et al. Delphi expert consensus of the German Thoracic Surgery Society on the management of chest tube drainage. Zentralbl Chir, 2020, 145(1): 99-107.
20.	高麗潔. 健康教育路徑對肺結核手術的護理影響分析. 內蒙古中醫藥, 2017, 36(11): 74-75.Gao LJ. Analysis of the impact of health education pathways on the care of tuberculosis surgery. Nei Mongol J Tradit Chin Med, 2017, 36(11): 74-75.
21.	李彥春, 邱鳳. 肺結核患者開胸術后肺部感染因素及有效的護理對策分析. 實用臨床護理學電子雜志, 2019, 4(20): 45, 50.Li YC, Qiu F. Analysis of pulmonary infection factors and effective nursing countermeasures after open-heart surgery in patients with pulmonary tuberculosis. Electron J Pract Clin Nurs Sci, 2019, 4(20): 45, 50.
22.	Finet M, Bellicha A, Sage E, et al. Comprehensive assessment of postoperative mobility during the first days after mini-invasive lung surgery: a prospective observational study. J Clin Anesth, 2023, 86: 111048.
23.	徐青, 朱陳燕, 郝力, 等. 多樣化護理干預對于肺結核合并糖尿病患者行肺葉切除術后康復的影響. 中華醫學會結核病學分會2019年全國結核病學術大會論文匯編, 2019.Xu Q, Zhu CY, Hao L, et al. Effect of diversified nursing interventions on rehabilitation after lobectomy in patients with tuberculosis combined with diabetes mellitus. 2019 National Tuberculosis Academic Conference of Chinese Society for Tuberculosis, 2019.
24.	曹曉霞. 肺結核大咯血行肺葉切除的圍手術期護理. 中國醫藥指南, 2017, 15(15): 222-223.Cao XX. Perioperative care of pulmonary lobectomy for tuberculosis hemoptysis. Guide China Med, 2017, 15(15): 222-223.
25.	Bando T, Onishi C, Imai Y. Treatment-associated symptoms and coping of postoperative patients with lung cancer in Japan: development of a model of factors influencing hope. Jpn J Nurs Sci, 2018, 15(3): 237-248.
26.	Dai W, Feng W, Zhang Y, et al. Patient-reported outcome-based symptom management versus usual care after lung cancer surgery: a multicenter randomized controlled trial. J Clin Oncol, 2022, 40(9): 988-996.
27.	Colla?o N, Henshall C, Belcher E, et al. Patients' and healthcare professionals' views on a pre- and post-operative rehabilitation programme (SOLACE) for lung cancer: a qualitative study. J Clin Nurs, 2022, 31(1-2): 283-293.

1. World Health Organization. Global tuberculosis report 2024. Geneva: World Health Organization, 2024.
2. World Health Organization Regional Office for Europe. The role of surgery in the treatment of pulmonary TB and multidrug- and extensively drug-resistant TB. World Health Organization, 2014.
3. Zaleskis R, Mariani AW, Inzirillo F, et al. The role of surgery in tuberculosis management: indications and contraindications. In: Migliori GB, Raviglione MC, eds. Essential Tuberculosis. Cham: Springer International Publishing, 2021: 141-148.
4. 中華醫學會結核病學分會. 中國耐多藥和利福平耐藥肺結核外科治療專家共識 (2022年版). 中華結核和呼吸雜志, 2023, 46(2): 111-120.Chinese Society for Tuberculosis, Chinese Medical Association. Expert consensus on surgical treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis in China (2022 edition). Chin J Tuberc Respir Dis, 2023, 46(2): 111-120.
5. 張法旺, 李森, 于新輝, 等. 不同切口手術聯合加速康復外科理念指導下的呼吸功能訓練在肺癌患者中的應用效果. 中國臨床醫學, 2024, 31(5): 778-782.Zhang FW, Li S, Yu XH, et al. Application effect of different incision surgeries combined with respiratory function exercise under the guidance of enhanced recovery after surgery concept in patients with lung cancer. Chin J Clin Med, 2024, 31(5): 778-782.
6. 劉穎. 個案管理的延伸護理服務對肺結核患者術后遵醫行為及生活質量的影響. 中國醫藥指南, 2020, 18(32): 225-226.Liu Y. Effect of extended nursing service of case management on post-operative compliance behavior and quality of life of patients with tuberculosis. Guide China Med, 2020, 18(32): 225-226.
7. 劉靜, 張娜. 個體化圍手術期護理在行肺切除術的肺結核病患者中的應用效果. 臨床醫學研究與實踐, 2020, 5(7): 156-158.Liu J, Zhang N. Application effect of individualized perioperative nursing on patients with pulmonary tuberculosis undergoing pneumonectomy. Clin Res Pract, 2020, 5(7): 156-158.
8. 中華人民共和國國家衛生和計劃生育委員會. WS 288—2017 肺結核診斷. 結核與肺部疾病雜志, 2024, 5(4): 376-378.National Health and Family Planning Commission of the People's Republic of China. WS 288—2017 diagnosis of tuberculosis. J Tuberc Lung Dis, 2024, 5(4): 376-378.
9. 朱云柯, 林琳, 廖虎, 等. 中國胸外科圍手術期疼痛管理專家共識(2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.Zhu YK, Lin L, Liao H, et al. Expert consensus on perioperative pain management in thoracic surgery in China (2018 edition). Chin J Clin Thorac Cardiovasc Surg, 2018, 25(11): 921-928.
10. 中國醫師協會胸外科醫師分會, 等. 胸部手術圍術期持續性肺漏氣管理策略全國專家共識(2023). 中華胸心血管外科雜志, 2024, 40(4): 193-200.Chinese Medical Doctor Association Thoracic Surgeon Branch, et al. Management strategies for persistent pulmonary air leak in the perioperative period of thoracic surgery: national expert consensus (2023). Chin J Thorac Cardiovasc Surg, 2024, 40(4): 193-200.
11. 張春曉, 趙世娣, 周靜怡. ABCD護理分級與主動氣道加溫濕化干預結合對急性肺炎病人癥狀改善效果及HAD評分的影響. 全科護理, 2021, 19(36): 5130-5133.Zhang CX, Zhao SD, Zhou JY. Effect of ABCD nursing grading combined with active airway warming and humidification intervention on symptom improvement effect and HAD score in patients with acute pneumonia. Chin Gen Pract Nurs, 2021, 19(36): 5130-5133.
12. 張露露, 王喜玲, 馬東波, 等. 肺結節對患者焦慮、抑郁評分的影響. 河南醫學研究, 2023, 32(6): 1009-1012.Zhang LL, Wang XL, Ma DB, et al. Influence of pulmonary nodules on anxiety and depression scores of patients. Henan Med Res, 2023, 32(6): 1009-1012.
13. Lu Y, Wang H, Zhu J, et al. Effect of targeted nursing intervention plus psychological counseling on quality of life, negative emotions, and complications in patients with extensively drug-resistant tuberculosis. Am J Transl Res, 2021, 13(12): 13950-13958.
14. Yuan W, Chai L, Wang J, et al. Integrated nursing and psychological intervention for tuberculosis complicated by lung cancer: clinical efficacy. Altern Ther Health Med, 2024.
15. 柳英, 盧森, 項玲, 等. 基于循證理念的康復護理對肺部手術患者的應用效果分析. 中國社區醫師, 2022, 38(32): 128-130.Liu Y, Lu S, Xiang L, et al. Analysis of application effect of evidence-based rehabilitation nursing in patients with lung surgery. Chin Community Dr, 2022, 38(32): 128-130.
16. 徐磊. 肺結核肺葉切除術后聯合胸腔負壓吸引治療的療效分析. 吉林醫學, 2018, 39(4): 739-741.Xu L. Analysis of the efficacy of combined negative pressure suction therapy of the chest after lobectomy for pulmonary tuberculosis. Jilin Med J, 2018, 39(4): 739-741.
17. 馬龍, 李德生, 張力為, 等. 負壓吸引對肺手術后康復效果的Meta分析. 中國醫藥科學, 2021, 11(7): 40-46.Ma L, Li DS, Zhang LW, et al. Meta-analysis of the efficacy of negative pressure suction on rehabilitation after lung surgery. China Med Pharm, 2021, 11(7): 40-46.
18. 黃歡. 肺術后漏氣患者應用負壓吸引引流的療效分析. 南昌: 南昌大學, 2024.Huang H. The efficacy analysis of negative pressure suction in patients with postoperative air leakage after lung surgery. Nanchang: Nanchang University, 2024.
19. Koryllos A, Eggeling S, Schega O, et al. Delphi expert consensus of the German Thoracic Surgery Society on the management of chest tube drainage. Zentralbl Chir, 2020, 145(1): 99-107.
20. 高麗潔. 健康教育路徑對肺結核手術的護理影響分析. 內蒙古中醫藥, 2017, 36(11): 74-75.Gao LJ. Analysis of the impact of health education pathways on the care of tuberculosis surgery. Nei Mongol J Tradit Chin Med, 2017, 36(11): 74-75.
21. 李彥春, 邱鳳. 肺結核患者開胸術后肺部感染因素及有效的護理對策分析. 實用臨床護理學電子雜志, 2019, 4(20): 45, 50.Li YC, Qiu F. Analysis of pulmonary infection factors and effective nursing countermeasures after open-heart surgery in patients with pulmonary tuberculosis. Electron J Pract Clin Nurs Sci, 2019, 4(20): 45, 50.
22. Finet M, Bellicha A, Sage E, et al. Comprehensive assessment of postoperative mobility during the first days after mini-invasive lung surgery: a prospective observational study. J Clin Anesth, 2023, 86: 111048.
23. 徐青, 朱陳燕, 郝力, 等. 多樣化護理干預對于肺結核合并糖尿病患者行肺葉切除術后康復的影響. 中華醫學會結核病學分會2019年全國結核病學術大會論文匯編, 2019.Xu Q, Zhu CY, Hao L, et al. Effect of diversified nursing interventions on rehabilitation after lobectomy in patients with tuberculosis combined with diabetes mellitus. 2019 National Tuberculosis Academic Conference of Chinese Society for Tuberculosis, 2019.
24. 曹曉霞. 肺結核大咯血行肺葉切除的圍手術期護理. 中國醫藥指南, 2017, 15(15): 222-223.Cao XX. Perioperative care of pulmonary lobectomy for tuberculosis hemoptysis. Guide China Med, 2017, 15(15): 222-223.
25. Bando T, Onishi C, Imai Y. Treatment-associated symptoms and coping of postoperative patients with lung cancer in Japan: development of a model of factors influencing hope. Jpn J Nurs Sci, 2018, 15(3): 237-248.
26. Dai W, Feng W, Zhang Y, et al. Patient-reported outcome-based symptom management versus usual care after lung cancer surgery: a multicenter randomized controlled trial. J Clin Oncol, 2022, 40(9): 988-996.
27. Colla?o N, Henshall C, Belcher E, et al. Patients' and healthcare professionals' views on a pre- and post-operative rehabilitation programme (SOLACE) for lung cancer: a qualitative study. J Clin Nurs, 2022, 31(1-2): 283-293.

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Latest ArticlesAnalysis of influencing factors for postoperative thoracic drainage duration in patients with cavitary pulmonary tuberculosis and clinical nursing strategies

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