老年自发性气胸75例临床特点分析

Clinical analysis of senile spontaneous pneumothorax:a report of 75 cases

目的探讨老年自发性气胸中继发性气胸与原发性气胸的临床特点。方法回顾我院2001年2月至2006年2月收治的75例老年自发性气胸患者的临床资料,其中继发性气胸48例,为A组,原发性气胸27例,为B组,将两组的临床特点进行分析比较。结果(1)临床表现:A组出现气急、心悸、呼吸衰竭和不稳定型气胸的比例分别为66.7%(32/48)、56.3%(27/48)、43.8%(21/48)和70.8%(34/48),B组分别为11.1%(3/27)、18.5%(5/27)、7.4%(2/27)和18.95%(5/27)。A组较B组明显增加,差异有显著性。(2)A组气胸类型以交通性气胸为主,B组以闭合性气胸为主,两组在气胸压缩面积、复发率等方面相比无显著性差异,但A组的误诊率为16.8%(8/48),较B组的0(0/27)明显增高,差异有显著性。(3)治疗与归转:A组平均治愈时间为24.2±2.1天较B组11.4±3.5天明显增加,差异有显著性。A组多采用胸腔闭式引流治疗,而B组多采用胸穿抽气治疗。两组病人经积极治疗后其治愈率和死亡率无差别。结论老年继发性气胸较原发性气胸症状重,临床表现不典型,易误诊,须及时诊断和治疗。

Objective To discuss clinical characteristics of senile spontaneous pneumothorax including secondary pneumothorax and primary pneumothorax.Methods Analyzed the clinical data of 75 patients with senile spontaneous pneumothorax hospitalized in our hospital from February 2001 to February 2006, retrospectively; among them 48 cases was secondary pneumothorax （group A）, 27 cases primary pneumothorax （group B）, and compared clinical characteristics of the two groups.Results （1） Clinical manifestations： the proportion of dyspnea, palpitation, respiratory failure and unstable pneumothorax in group A were 66.7%（32/48）、56.3%（27/48）、43.8%（21/48）and 70.8%（34/48）, respectively; while 11.1%（3/27）、18.5%（5/27）、7.4%（2/27）and 18.95%（5/27）in group B. The proportion of symptoms mentioned above in group A was much higher than that in group B with statistical significant difference.（2） Group A was mainly open pneumothorax, while group B tension pneumothorax. No difference was found in pneumothorax compression areas and recurrence rate between the two groups. Misdiagnosis rate was higher in group A（8/48）than in group B（0/27）with statistical significant difference.（3） Treatment and recovery： the average healing time of group A was 24.2±2.1 days, more than that of group B which was 11.4±3.5 days, and statistical difference was observed. Group A mainly underwent thoracic closed drainage, while group B was mostly performed thoracentesis to aspirate air. No difference in the cure rate and mortality between the two groups after treatment.Conclusion Senile secondary pneumothorax has more severe symptoms than primary pneumothorax, with atypical clinical manifestations, it is easily misdiagnosed, and it needs timely diagnosis and treatment.