中心静脉导管胸腔闭式引流术加持续负压吸引治疗气胸

Treatment of Spontaneous Pneumothorax with Central Venous Catheter and Continuous Negative Pressure Drainage Suction

目的：探讨中心静脉导管胸腔闭式引流术加持续负压吸引治疗气胸的有效性、安全性、局限性。方法：以14G中心静脉导管以经皮扩张法置入胸腔行胸腔闭式引流加床旁持续负压吸引治疗自发性气胸,与传统粗导管胸腔闭式引流对照,行统计学分析。结果：①我院住院自发性气胸病因中以原发性为主,占67.24%;②中心静脉导管组与传统粗导管组在治愈病人中达到肺复张且停止漏气的时间无显著差异;中心静脉导管组中COPD合并气胸病人有效率低于非COPD合并气胸病人,差异有显著性（P〈0.01）;③中心静脉导管组与传统粗导管组比胸痛发生率低（P〈0.01）,脱管发生率低（P〈0.05）。结论：中心静脉导管胸腔闭式引流术加持续负压吸引治疗自发性气胸较传统粗导管胸腔闭式引流操作简易、损伤小、易于管理,对非阻塞性肺疾病的自发性气胸病人疗效理想,但对阻塞性肺疾病的自发性气胸病人应慎用,且不适于危重气胸。

Object： To study of the availability, safety and limits of treatment of spontaneous pneumothorax with central venous catheter and continuous negative pressure suction. Method： Central venous catheter of 14G was put thoracic cavity with percutaneous dilation. Spontaneous pneumothorax, was treated closed thoracic drainage and continuous negative pressure suction. The result was compared with traditional closed thoracic drainage with thick catheter. Statistical analysis was conducted. Result： 1. The majority of spontaneous pneumothorax in our hospital is primary, which is 67.24%. 2. There is no significant difference of the time of pulmonary reexpansion and no air leakage between central venous catheter group and traditional thick catheter group. The availability of spontaneous pneumothorax with COPD was lower than spontaneous pneumothorax without COPD. The difference is significant （P〈0.01）. Incidences of chest pain and catheter drop in central venous catheter group were lower than those in traditional thick catheter group（P〈0.01, P〈0. 05） . Conclusion： Compared with traditional closed thoracic drainage with thick catheter, treatment of spontaneous pneumothorax with central venous catheter and continuous negative pressure suction is more easily operated, managed and has slight injuries. It is fit for spontaneous pneumothorax without COPD. But treatment of spontaneous pneumothorax with COPD should be careful with the method and it is unfit for critical pneumothorax.