早期自体血补片胸膜固定术治疗难治性气胸的临床研究

Clinical study of early autologous blood patch pleurodesis in the treatment of refractorypneumothorax

目的本研究诣在观察对比早期应用自体血补片胸膜固定术治疗难治性气胸的疗效及安全性。方法我院2019年1月-2021年5月共收治228例SSP患者,将置管后漏气时间大于5日的73例患者(男70例、女3例,年龄32~86岁,平均年龄64.3±11.5岁)纳入研究,分为2组进行对照试验,其中漏气时间>14日7例患者归为晚期对照组(C组),34例为中期对照组(B组),实验组(A组)32例早期进行自体血胸膜固定术ABPP,5日后对照组仍漏气患者及实验组未愈患者再进行自体血胸膜固定术,记录并比较两组胸膜固定术后漏气停止时间、总带管时间、有效率、并发症等情况。结果实验组首次ABPP后5日治愈率明显高于对照组单纯引流治疗(81.3%vs.32.4%,P<0.0001),与中期对照组治愈率无明显差异(81.3%vs.91.3%,P=0.512),各组ABPP后停止漏气时间无明显差异(3.3±1.8d vs 3.2±1.7d vs 3.4±1.4d,P=0.958),实验组总带管时间低于中期对照组(9.3±2.2d vs.15.4±2.5d,P<0.0001)。结论自体血补片胸膜固定术是治疗难治性气胸的有效方法,尤其适用于无法手术的病人,它具有易于取材、操作简便、副反应低等优点,早期应用自体血补片可以明显缩短带管时间,减少患者痛苦。

Objective To observe and compare the efficacy and safety of early application of autologous blood patch pleurodesis in the treatment of refractory pneumothorax.Methods Between January 2019 to May 2021,a total of 228 patients with secondary spontaneous pneumothorax(SSP)were treated in our hospital.73 patients(70 males and 3 females,range 32~86 years,mean age 64.3±11.5 years)of them with air leakage more than 5 days after thoracic drainage were included in the study and were divided into 2 groups for a controlled trial.Seven patients with air leakage for more than 14 days belong to the later control group(group C),and 34 patients belong to the middle control group(group B).32 patients in the experimental group(group A)underwent autologous blood patch pleurodesis(ABPP)in the early stage.After 5 days,the patients in the control group who still had air leakage and the patients in the experimental group who were not healed underwent the treatment of ABPP again.The duration required for air leak to seal,chest drainage duration,effective rate,and complications were compared and statistically analyzed.Results The cure rate 5 days after the first ABPP in the experimental group was significantly higher than that in the control group with drainage alone(81.3%vs.32.4%,P<0.0001),but there was no significant difference with the middle control group(81.3%vs.91.3%,P=0.512).There was no significant difference in the days to air leak seal after ABPP among all groups(3.3±1.8d vs 3.2±1.7d vs 3.4±1.4d,P=0.958),and the total duration of tube removal in the treated group was shorter than that in the middle control group B(9.3±2.2d vs.15.4±2.5d,P<0.0001).Conclusion ABPP is an effective method for the treatment of refractory spontaneous pneumothorax,especially for inoperable patients.It has the advantages of easy getting,simple operation,and low side effects.Early application of ABPP can shorten the tube-carrying time and reduce the pain of patients.