局限性气胸诊治中的一些问题

The Problems of Diagnosis and Treatment in Localized Pneumothorax

80年代局限性气胸的发生率较前明显增高。本病多继发于慢性阻塞性肺病,可无突然发病,但常反复发作。气胸的症状和体征不典型,常被肺部基础疾病的征象所掩盖,但每呈呼吸衰竭的表现。局限于前、后胸腔的气胸,正位胸片常易漏诊。胸腔内置入蕈形导管排气具有疗效好,无压迫损伤肺组织阻碍肺复张和避免皮下气肿等优点,可试用于临床。

The data in this paper showed that the incidence of hospitalized patients of localized pneumothorax from 1.7％ in the 70s' have increased to 7.2％ in the 80s' The clinical manifestations of localized pneumothorax are characterized by:(1)the age of these patients is almost more than 50, the most likely underlying diseases of the lungs are chronic bronchitis with obstructive emphysema;(2)the onset of the localized pneumotborax may be insidious and the symptoms of abrupt chest pain and breathlessenss are usually absent, being covered by the features of the underlying diseases of the lungs;(3) the episode of pneumothorax is often recurrent;(4)although the lung is partialy collapsed by the localized pneumothorax, very serious respiratory failure could result, this is due to pulmonary dysfunction of these patients had existed before the onset of the pneumothorax;(5) the typical sign of pneumothorax are usually absent exoept for the clinical finding of the underlying diseases of the lungs;(6) most of these patients had tension pneumothorax;(7) if the pneumothorax is localized in the anterior or posterior pleural space, it could be very difficult to demonstrate the free air by a post-anterior chest film. In order to avoid the lethal respiratory failure to occur, one must rolleve the tension from the pleural space as soon as possible. The benefit of a mushroom catheter is it will not injury the lungs, and it can avoid the air escaping from the localized pneumothorax space into the subcutaneous area.Therefore, we suggest that the mushroom catheter can be used for the management of localized pneumothorax.