胸腔内注入冷沉淀预防复发性气胸的研究

Study on Prevention of Spontaneous Pneumothorax Recurrence by Intrapleural Instillation of Cryoprecipitate

目的：探讨胸膜腔内注入冷沉淀能否降低自发性气胸的同侧复发率。方法：３年间采用随机法将６６例自发性气胸分为粘连组３４例，给予冷沉淀２Ｕ（４０ｍｌ）胸膜腔注入；对照组３２例，单纯行胸腔闭式引流治疗。于第３年随访，对其症状、体征、胸部Ｘ线及肺功能检查，平均随访期（２３．６±９．１）月。结果：胸膜腔内注入冷沉淀无明显不良反应，胸部Ｘ线检查未提示胸膜增厚，各组１０例特发性气胸（随访在１年以上）的肺功能检查比较无明显差异（Ｐ＞０．０５）；粘连组与对照组的复发率分别为６．９％（２／２９）和３７％（１０／２７），有显著性差异（Ｐ＜０．０５）。结论：胸膜腔内注入冷沉淀能有效地降低同侧气胸的复发率，且不会导致限制性肺功能障碍。既适用于特发性、初发性气胸，也适用于继发性、复发性气胸，对于难治性气胸和年老体弱。

Objective:To inquire into the possibility of intrapleural instillation of cryoprecipitate to lower the recurrence rate of ipsilateral spontaneous pneumothorax.Methods:66 patients were recruited and randomly divided into the adhesion group of 34 patients and the control group of 32 patients over last three years.The adhesion group was treated by intrapleural instillation of cryoprecipitate in dosage of 2U which amounts to 40ml.The control group was treated only by closed intrapleural drainage.In the third year, that is,1996,the patients were followed up to examine their symptoms,physical signs,chest radiograph and pulmonary function.The average followup period was (23.6±91) months.Results:There was no obvious negative reaction in the patients treated by intrapleural instillation of cryoprecipitate and no pleural thickening on the chest radiograph.And there was no significant difference in pulmonary function test between 10 cases of idiopathic pneumothorax in the former group and 10 cases of idiopathic pneumothorax in the latter group when the time of follow up was more than one year(P>005).The recurrence rate of pneumothorax in the former group and in the latter group was 6.9%(2/29) and 37%(10/27),respectively indicating that there was significant difference (P<005).Conclusion: The intrapleural instillation of cryoprecipitate could significantly lower the recurrence rate of ipsilateral pneumothorax,and could not lead to restrictive pulmonary dysfunction.The mentioned above therapy can be applicable not only for treatment of idiopathic and primary pneumothorax,but also for treatment of secondary and recurrent pneumothorax.It also can be as alternative therapy for treatment of refractory pneumothorax,and for treatment of the weak and old patients with bad pulmonary function.