早期排气与延迟排气对原发性自发性气胸疗效的差异比较

Comparison of the outcomes of spontaneous pneumothorax treated with early or delayed air drainage

目的探讨早期排气与延迟排气对原发性自发性气胸疗效的影响，并比较二者的近期疗效。方法对1998年7月至2006年6月山东省潍坊市人民医院呼吸科就诊的264例原发性自发性气胸患者进行研究，分为早期排气组（142例）和延迟排气组（122例），分别于3d内及第7天进行治疗，观察住院时间及治疗失败率等近期疗效，并随访2年观察气胸复发次数及胸膜粘连等远期疗效。结果早期排气组住院时间为（18±6）d，延迟排气组为（6±2）d。早期排气组中气胸量20％～50％的患者51例，其中44例于第1次抽气后气胸量增加，改为胸腔插管引流；气胸量〉50％的患者行插管引流91例，其中12例因持续漏气转入胸外科行手术治疗。延迟排气组122例中81例于第1次抽气时抽尽气体，其余41例初次抽气出现咳嗽或呼吸困难加重，于次日将气体全部抽尽，均未发生气胸加重、复张性肺水肿或抽气失败。2年内随访例数243例，早期排气组随访128例，延迟排气组115例，结果显示延迟排气组复发5例，早期排气组复发29例，经外科手术者均未复发。早期排气组及延迟排气组分别有79例和0例X线胸片显示胸膜粘连，两者比较差异有统计学意义（P〈0．05）。结论临床干预时间的早晚可影响患者预后，延迟排气治疗对原发性自发性气胸患者可缩短住院时问，降低胸膜粘连及气胸复发率。

Objective To explore the outcomes between the early or delayed air drainage for spontaneous pneumothorax. Methods The present prospective study was designed to evaluate the efficacy and complications. 242 patients with primary spontaneous pneumothorax were randomly allocated to early （ 〈72 h） group （n = 142） or delayed （ 〉6 d） exhaust air group （n = 122） , the recent success rates, average time in hospital, recurrences rates, and pleura adhesion rates were evaluated. Results Average time in hospital ： early group and delayed group respectively was （ 18 ±6 ） d vs （ 6 ± 2 ） d. In early group, the amount of pneumothorax was between 20% to 50% , 51 cases were aspirated and 44 of them were increased after first aspiration, whom were subsequently treated by intercostal drainage. Size of pneumothorax more than 50% ,98 patients treated by intercostal drainage. 12 of 142 patients with persistence leak air transferred to surgery. In delayed group, all of 122 aspirations were successful at the first time. There were significant differences between the 2 groups in recent successful rate. 29 of the 128 patients in early group and 5 of the 115 had a relapsing pneumothorax. During the 2 year follow-up period, 79 of the 128 patients in early group and none of the 115 had radiographic pleural adhesions appearances. Conclusion The time of air drainage was associated with outcomes of primary spontaneous pneumothorax. These data suggest that delayed intervention is an effective initial treatment strategy for patients with PSP, with a shorter time in hospital, fewer pleural adhesions and lower recurrence rates.