自发性气胸139例临床分析

Clinical analysis of 139 cases with spontaneous pneumothorax

目的:探讨总结影响自发性气胸肺复张及呼吸功能的相关因素。方法:用Cox风险比例模型对影响可能影响自发性气胸的相关影响因素(性别、年龄、初诊肺压缩比、有否合并COPD、血胸量、是否复发性气胸、有否合并肺部感染)7项指标进行多因素回顾分析。对以上因素是否影响患者的呼吸功能进行相关分析。结果:压缩比是影响肺复张的最明显因素(P<0.05);单侧自发性气胸患者合并存在COPD是影响患者呼吸功能的最密切的因素(P<0.05)。结论:单侧自发性气胸患者如果肺压缩超过60%可行胸腔闭式引流,如果效果欠佳应尽早转手术治疗;单侧自发性气胸患者如果合并存在COPD即使肺压缩达不到30%,只要经解痉、吸氧,血氧饱和度达不到90%,就应该行胸腔抽气或患侧胸腔闭式引流术。

Objective:The aim of this study was to explore the factors affecting lung reexpansion and respiratory functions for the patients with spontaneous pneumothorax. Methods:The influential factors for spontaneous pneumothorax such as genders,age,pneumothorax size for the first diagnosis,accompanied with COPD or not,accompanied with pneamonia or not,blood volume for the hemothorax,and recurrent pneumothorax or not were screened using the Cox model. The correlation analysis between the influential factors and the respiratory functions were also performed. Results:Pneumothorax size was the most obvious influential factor for lung reexpansion(P<0.05). Unilateral spontaneous pneumothorax accompanied with COPD was the most important risk factor for respiratory functions(P<0.05). Conclusion:The unilateral spontaneous pneumothorax patients with neumothorax size more than 60% should receive thoracic closed drainage and transfer to surgery as soon as possible if the above treatment is ineffective. The unilateral spontaneous pneumothorax patients with pneumothorax size less than 30% accompanied with COPD should receive thoracic cavity pumping or thoracic closed drainage therapy if the artery blood oxygen saturation less than 90% after antispasmodic and oxygen inhalation therapy.