高渗糖胸腔灌洗治疗弥漫性肺气肿并气胸的疗效分析

Clinical analysis of hypertonic glucose pleuroclysis in 21 cases of homogeneous pulmonary emphysema with pneumothorax

目的探讨高渗糖胸腔灌洗治疗弥漫性肺气肿并发气胸患者的疗效。方法治疗组21例使用胸腔闭式引流加高渗糖胸腔灌洗疗法,将预混的50%高渗糖40 mL+2%利多卡因10 mL+地塞米松10 mg共50 mL从胸腔引流管中一次性注入,患者取头低足高仰卧位并让患者翻身使药液分布均匀,夹闭胸腔引流管1 h后放开,1次/d。对照组17例仅用闭式引流。结果 2组病例在年龄、性别构成,气胸部位,肺压缩比例方面均相似。治疗组的平均拔管时间(5.6±1.8)d,平均住院时间(7.6±2.1)d,随访复发率4.8%,对照组分别为(7.3±2.5)d、(11.3±2.7)d、29.4%,P<0.05。结论高渗糖胸腔灌洗治疗无肺减容术指征的弥漫性肺气肿并发气胸患者,对改善气胸症状,缩短住院时间,降低复发率,提高患者生活质量疗效明确,若能适当使用,并尽量减轻其不良反应,不失为治疗该类病人的一种好方法。

Objective To investigate the effective of hypertonic glucose pleurolysis in the treatment of homogeneous pulmonary emphyse- ma with pneumothorax. Methods The treatment group ,21 cases of homogeneous emphysema with pneumothorax were collected using the thera- py of hypertonic glucose pleuroclysis through closed chest drainage. Admixed 40 mL of 50% hypertonic glucose plus 10 mL of 2% lidocaine and dexamethasone 10mg ,the mixture of 50 mL were delivered into thoracic cavity through closed chest drainage when patients were in a trendelen- burg position. After - while ,we clipped the drainage for 1 hour and told patients to roll their body in order to scatter the solution well - distrib- utedily. The above method was performed one time a day for every patient. The control group with 17 cases was treated by chest drainage alone. Results There was no significant difference in demographic data among the two groups. The treatment group had significantly short hospital stay days compared with the control group （ 7.6 -＋ 2.1 to 11.3 -＋ 2.7 days ; P 〈 0.05 ）, short chest drainage days （5.6 -＋ 1.8 to 7.3 ＋ 2.5 days ; P 〈 0.05 ）, and a low recurrence rate of follow - up （4.8 % to 29.4% ;P 〈 0.05 ）. Conclusion For the homogeneous emphysema patients with pneumothorax,who have no indications of lung volume reduction surgery, the treating effect of hypertonic pleuroclysis is definite. By utilizing correctly and reducing adverse reaction as far as possible. This method is a good option for treating this kind of people.