83例老年自发性气胸诊疗体会

Clinical investigation of 83 cases of spontaneous pneumothorax in aged patients

目的:探讨老年自发性气胸的临床特点及治疗方法。方法:对本院2000年10月～2009年4月收治的83例老年自发性气胸患者临床资料进行回顾性分析。结果:老年自发性气胸大多有肺部基础疾病(85.5%),反复发作,且病情较重,愈后差,死亡率高(9.6%);临床表现缺乏特异性,本组误诊率为18.1%;主要采用胸腔闭式引流及胸膜内药物注入粘连为主的治疗措施,气胸复发率较低(3.6%);适时采用胸腔镜治疗能缩短胸腔闭式引流时间,减少患者住院天数。结论:老年自发性气胸大多有肺部基础疾病,病情较重,且反复发生,容易误诊;采用胸腔闭式引流及胸膜腔内药物注入粘连的胸膜内固定术,可预防气胸复发,对胸腔闭式引流效果不佳及复发的自发性气胸患者可首选胸腔镜治疗以缩短闭式引流时间,提高老年人生活质量。

Objective： To investigate the clinical feature and treatment method of spontaneous pneumothorax in aged patients. Methods： From October 2000 to April 2009, 83 aged patients with spontaneous pneumothorax were analyzed retrospectively. Results： Most of the aged patients with spontaneous pneumothorax had pulmonary underlying diseases （85.5%） with a repeatedly occurrence,poor prognoses and high mortality（9.6%）. Clinical manifestation lacked specificity. The misdiagnosis rate of this group was 18.1%. The patients were mainly treated with closed thoracic drainage and adhesion of drug injection in pleura for the lower recurrence rate（3.6%）. Timely treatment of thoracoscope could shorten the time of closed thoracic drainage and hospitalization days of the patients. Conclusion： Most of the aged patients with spontaneous pneumothorax have pulmonary underlying diseases（85.5%） with a repeatedly occurrence and easy misdiagnosis. Closing thoracic drainage and fixation operation in pleura like adhesion of drug injection in pleural cavity can prevent recurrence of pneumothorax.Thoracoscopic treatment seems to be the first choice for patients whose closed thoracic drainages are ineffective and those who have a recurrence of spontaneous pneumothorax in order to reduce the closed drainage time and improve the life quality of these old.