急诊微创引流治疗自发性气胸临床研究

Minimally invasive drainage for treatment of spontaneous pneumothorax in emergency depatment

目的：评价急诊应用中心静脉导管微创负压引流治疗自发性气胸的临床疗效。方法选择2010年10月～2013年9月在我院急诊留观住院的71例自发性气胸患者，采用数字表随机方法分为中心静脉导管微创负压引流组与传统胸管引流组，比较两组患者的肺复张率、肺复张时间等有效性指标及胸膜反应、疼痛程度等安全性指标，并电话随访1年内复发情况，比较两组复发率。结果两组患者肺复张率、肺复张时间、平均住院时间、平均住院费用、1年内复发率比较，差异无显著统计学意义（P＞0.05），两组胸膜反应、血胸、皮下气肿、堵管发生率、肺部感染、切口感染发生率比较，差异无显著统计学意义（P＞0.05）；但导管组疼痛程度显著低于传统组（P＜0.05）。结论急诊应用中心静脉导管微创负压引流治疗原发性气胸的疗效满意，而且具有创伤小、疼痛程度低、并发症少等优点，值得临床推广应用。

Objective Evaluate the clinical efficacy of central venous catheter negative pressure drainage in treat‐ment of spontaneous pneumothorax in emergency department . Methods From October 2010 through September 2013 ,71 cases with spontaneous pneumothorax were randomly divided into central venous catheter negative pres‐sure drainage group or conventional chest tube drainage group to compare the effective and safety indicators inclu‐ding the rate of lung reexpansion ,the time of lung reexpansion ,pleural reaction time ,the degree of pain and etc .In addition ,the rate of one‐year recurrence were followed up by telephone to compare these two groups . Results There were no significant difference in the rate of lung reexpansion ,time of lung Reexpansion ,average length of stay ,average hospital costs and rate of one‐year recurrence between groups（P〉 0.05） .Moreover ,similar results were observed in the rate of pleural reaction ,hemothorax ,subcutaneous emphysema ,rate of tube blocked ,pulmona‐ry infection and wound infection（P〉0.05） .However ,the venous catheter negative pressure drainage group showed significantly lower degree of pain（P〈0.05） . Conclusion Central venous catheter negative pressure drainage in treatment of spontaneous pneumothorax resultes in significant therapeutic effect ,as evidenced by less invasive ,low pain ,fewer complications and thus can be clinically valuable to popularize .