吸氧对特发性自发性气胸胸腔气分压的影响及其临床意义

Clinical significance of oxygen therapy in primary spontaneous pneumothorax

目的探讨高浓度吸氧前、后特发性自发性气胸不同临床分型患者胸腔气分压的变化特点及治疗价值。方法纳入天津市胸科医院特发性自发性气胸患者,根据其血气、呼出气和胸腔气分析的结果分为闭合性气胸组(57例)和开放性气胸组(51例)。2组分别给予高浓度面罩吸氧6 h后复测血气、呼出气和胸腔气,比较氧疗前后动脉血、呼出气、胸腔气氧分压[p(O2)]和动脉二氧化碳分压[p(CO2)]并进行相关数据分析。结果2组吸氧前和吸氧后动脉血气p(O2)和p(CO2)差异均无统计学意义,且2组动脉血气Δp(O2)差异亦无统计学意义(P>0.05)。2组吸氧前和吸氧后呼出气p(O2)和p(CO2)差异均无统计学意义(P>0.05)。吸氧后闭合性气胸组胸腔气p(O2)较吸氧前下降(P<0.05),开放性气胸组胸腔气p(O2)较吸氧前升高(P<0.05)。2组吸氧前后p(CO2)无明显变化(P>0.05)。结论高浓度吸氧后胸腔气分压下降,有利于闭合性气胸胸腔气体的吸收和患肺复张,但对开放性气胸的作用不明显。

Objective To study the changes of oxygen partial pressure[p(O2)]and carbon dioxide partial pressure[p(CO2)]of the pleural cavity gas before and after oxygen therapy in patients with primary spontaneous pneumothorax(PSP).Methods One hundred and twenty hospitalized PSP patients were divided into two groups:closed pneumothorax group(n=57)and open pneumothorax group(n=51)according to the p(O2)and p(CO2)of the arterial blood gas,expiratory gas and pleural cavity gas.The two groups were given high concentration oxygen mask for 6 hours,and then the blood gas,expiratory gas and pleural cavity gas were measured again.The levels of p(O2)and p(CO2)of the arterial blood,expiratory gas and thoracic oxygen partial pressure before and after oxygen therapy were compared and analyzed.Results There were no significant differences in values of p(O2)and p(CO2)in arterial blood gas before and after oxygen therapy between the two groups(P>0.05).There were no significant differences in values ofΔp(O2)in arterial blood gas after oxygen therapy between the two groups(P>0.05).There were no significant differences in values of p(O2)and p(CO2)in expiratory gas before and after oxygen therapy between the two groups(P>0.05).The level of p(O2)of pleural cavity gas was lower after oxygen therapy than that before oxygen therapy in patients with closed pneumothorax(P<0.05).The level of p(O2)of pleural cavity gas was higher after oxygen therapy than that before oxygen therapy in patients with open pneumothorax(P<0.05).There were no significant differences in values of p(CO2)of pleural cavity gas before and after oxygen therapy between the two groups(P>0.05).Conclusion The high concentration oxygen therapy is beneficial to the absorption of pleural cavity gas and recruitment of lung in patients with close pneumothorax,but the effect on open pneumothorax is not obvious.