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.	中华医学会结核病学分会. 中国耐多药和利福平耐药肺结核外科治疗专家共识 (2022年版). 中华结核和呼吸杂志, 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.	张法旺, 李森, 于新辉, 等. 不同切口手术联合加速康复外科理念指导下的呼吸功能训练在肺癌患者中的应用效果. 中国临床医学, 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.	刘颖. 个案管理的延伸护理服务对肺结核患者术后遵医行为及生活质量的影响. 中国医药指南, 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.	刘静, 张娜. 个体化围手术期护理在行肺切除术的肺结核病患者中的应用效果. 临床医学研究与实践, 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.	中华人民共和国国家卫生和计划生育委员会. WS 288—2017 肺结核诊断. 结核与肺部疾病杂志, 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. 中国胸外科围手术期疼痛管理专家共识(2018版). 中国胸心血管外科临床杂志, 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.	中国医师协会胸外科医师分会, 等. 胸部手术围术期持续性肺漏气管理策略全国专家共识(2023). 中华胸心血管外科杂志, 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.	张春晓, 赵世娣, 周静怡. ABCD护理分级与主动气道加温湿化干预结合对急性肺炎病人症状改善效果及HAD评分的影响. 全科护理, 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.	张露露, 王喜玲, 马东波, 等. 肺结节对患者焦虑、抑郁评分的影响. 河南医学研究, 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, 卢森, 项玲, 等. 基于循证理念的康复护理对肺部手术患者的应用效果分析. 中国社区医师, 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. 肺结核肺叶切除术后联合胸腔负压吸引治疗的疗效分析. 吉林医学, 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.	马龙, 李德生, 张力为, 等. 负压吸引对肺手术后康复效果的Meta分析. 中国医药科学, 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.	黄欢. 肺术后漏气患者应用负压吸引引流的疗效分析. 南昌: 南昌大学, 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.	高丽洁. 健康教育路径对肺结核手术的护理影响分析. 内蒙古中医药, 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.	李彦春, 邱凤. 肺结核患者开胸术后肺部感染因素及有效的护理对策分析. 实用临床护理学电子杂志, 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, 朱陈燕, 郝力, 等. 多样化护理干预对于肺结核合并糖尿病患者行肺叶切除术后康复的影响. 中华医学会结核病学分会2019年全国结核病学术大会论文汇编, 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.	曹晓霞. 肺结核大咯血行肺叶切除的围手术期护理. 中国医药指南, 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.	Collaço 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. 中华医学会结核病学分会. 中国耐多药和利福平耐药肺结核外科治疗专家共识 (2022年版). 中华结核和呼吸杂志, 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. 张法旺, 李森, 于新辉, 等. 不同切口手术联合加速康复外科理念指导下的呼吸功能训练在肺癌患者中的应用效果. 中国临床医学, 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. 刘颖. 个案管理的延伸护理服务对肺结核患者术后遵医行为及生活质量的影响. 中国医药指南, 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. 刘静, 张娜. 个体化围手术期护理在行肺切除术的肺结核病患者中的应用效果. 临床医学研究与实践, 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. 中华人民共和国国家卫生和计划生育委员会. WS 288—2017 肺结核诊断. 结核与肺部疾病杂志, 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. 中国胸外科围手术期疼痛管理专家共识(2018版). 中国胸心血管外科临床杂志, 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. 中国医师协会胸外科医师分会, 等. 胸部手术围术期持续性肺漏气管理策略全国专家共识(2023). 中华胸心血管外科杂志, 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. 张春晓, 赵世娣, 周静怡. ABCD护理分级与主动气道加温湿化干预结合对急性肺炎病人症状改善效果及HAD评分的影响. 全科护理, 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. 张露露, 王喜玲, 马东波, 等. 肺结节对患者焦虑、抑郁评分的影响. 河南医学研究, 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, 卢森, 项玲, 等. 基于循证理念的康复护理对肺部手术患者的应用效果分析. 中国社区医师, 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. 肺结核肺叶切除术后联合胸腔负压吸引治疗的疗效分析. 吉林医学, 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. 马龙, 李德生, 张力为, 等. 负压吸引对肺手术后康复效果的Meta分析. 中国医药科学, 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. 黄欢. 肺术后漏气患者应用负压吸引引流的疗效分析. 南昌: 南昌大学, 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. 高丽洁. 健康教育路径对肺结核手术的护理影响分析. 内蒙古中医药, 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. 李彦春, 邱凤. 肺结核患者开胸术后肺部感染因素及有效的护理对策分析. 实用临床护理学电子杂志, 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, 朱陈燕, 郝力, 等. 多样化护理干预对于肺结核合并糖尿病患者行肺叶切除术后康复的影响. 中华医学会结核病学分会2019年全国结核病学术大会论文汇编, 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. 曹晓霞. 肺结核大咯血行肺叶切除的围手术期护理. 中国医药指南, 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. Collaço 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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