肺大泡并发血气胸的危险因素分析及防治要点

Risk factors of pneumatocele with hemopneumothorax and key points of prevention and treatment

目的:分析肺大泡并发血气胸的危险因素及防治要点,为预防肺大泡并发血气胸提供参考。方法:收集分析2017年3月至2019年4月,上海市胸科医院(上海交通大学附属胸科医院)收治的肺大泡患者100例的临床资料,对肺大泡并发血气胸的危险因素进行Logistic多因素回归分析,并提出相关防治要点。结果:100例肺大泡患者中,有78例出现肺大泡并发症,其中自发性血气胸有43例;肺大泡形成位置多集中在肺上叶;肺大泡患者的性别、肺大泡位置、发病诱因、是否属首次发病及合并基础疾病与并发血气胸无关(P>0.05);年龄、肺大泡分型、BMI与并发血气胸有关(P<0.05);Logistic回归分析显示,年龄和肺大泡分型是肺大泡并发血气胸的危险因素(P<0.05),而BMI是其保护因素(P<0.05)。结论:肺大泡并发血气胸的危险因素主要包括:年龄和肺大泡分型,临床上需及时对无症状的肺大泡患者行胸腔CT检查,需要有进一步的研究证实必要的预防性肺大泡切除术手术可能降低血气胸发生率。

Objective:To investigate risk factors and preventive issues of pneumatocele with hemopneumothorax.Methods:The clinical data of 100 patients with pneumatocele who were admitted to Shanghai Chest Hospital,(Shanghai Chest Hospital Affiliated Shanghai Jiao Tong University)from March 2017 to April2019 were collected and analyzed.Logistic multivariate regression analysis was performed to analyze risk factors of pneumatocele with hemopneumothorax,and key points of prevention and treatment were proposed.Results:Of the subjects,there were 78 cases with complications,including 43 cases with spontaneous hemopneumothorax.The locations of pneumatocele mainly included upper lobes of lungs.The gender,location of pneumatocele,causes of the disease,the first onset or not and basic diseases were not related to hemopneumothorax in patients with pneumatocele(P>0.05),while age,type of pneumatocele,weight and BMI were related to hemopneumothorax(P<0.05).Logistic regression analysis showed age and pneumatocele typing were independent risk factors for pneumatocele complicated with hemopneumothorax(P<0.05),while BMI was a protective factor(P<0.05).Conclusions:The independent risk factors for pneumatocele with hemopneumothorax mainly include age and type of pneumatocele.Clinically,patients with asymptomatic pneumatocele should be examined with chest CT.Further study is needed to investigate whether prophylactic resection of pneumatocele can reduce the incidence of hemopneumothorax.