老年自发性气胸的临床诊断和治疗探讨（附62例临床分析）

PROBING INTO CLINICAL DIAGNOSIS AND TREATMENT OF SPONTANEOUS PNEUMOTHORADX IN THE AGED(With 62 Cases of Clinical Analysis Reported)

对６２例６０岁以上老年人自发性气胸与同期５８例３０岁以下自发性气胸的对比分析显示，气胸类型两组均以闭合性气胸居多；老年组发病危急，并发症、合并症多，易误诊误治；因各种原因未能进行Ｘ线检查者，老年组３２例，占５１．６％，显著高于对照组（仅３例，占５．２％）；这一部分病人的临床诊断主要依赖体格检查，其判断标准应为：①凡锁骨中带叩过反响阳性伴气管移位者，即可认定诊断；②锁骨中带叩过反响阳性不伴气管移位，能除外心源性疾患者，则可拟定诊断。治疗上低正负压交替引流的疗效明显优于水封瓶引流。建议凡需抽气引流减压的病例，均应用低正负压交替引流。

A comparative analysis of spontaneous pneumothorax between 62 patientsabove 60 years old and 58 patients below 30 years old during the same peried showed thatclosed pneumothorax was dominant in both groups; clinical manifestations were much severerand incidence of complications was higher,and misdiagnosis and mistredtment occured more fre-quently in the aged group; 32 patients( 5 1.7%)of the aged group which was much higher thanthe control group(3 patients,5.2%)failed to do X-ray examination because of different rea-sons. The clinical diagnosis of these patients based on physical findings. The diagnostic criterions were that(1) a comfirmed diagnosis could be made by hyperresonant percussion note at middleareas of clavicle accompanying with tracheal displacement;(2)a supposed diagnosis could bemade by hyperresonant porcussion note without tracheal displacement,excl uding cardiac diseases.In treatment,peitive-negative alternating low pressure drainage was much more effective thanclosed drainage with water-sealed bottle(P<0.01),It was advised that patients who need todraw atr to reduce pressure should take positive-negative alternating low pressure drainage.