Spontaneous Pneumothorax Complicating Miliary Tuberculosis: About a Case at the “Centre Medical Principal De La Gendarmerie Nationale Du Mali”

Introduction: Spontaneous pneumothorax is a rare but serious complication of tuberculosis. Miliary tuberculosis (MT) is a severe form of tuberculosis secondary to hematogenous spread of Mycobacterium tuberculosis. Objective: To report a case of MT complicated by pneumothorax. Methodology: This was a 25-year-old patient, farmer, followed up at the Pneumo-phtisiology department of the CHU du Point G for MT whose condition was improving after the introduction of anti-tuberculosis chemotherapy. He consulted again after experiencing chest pain. Clinical and imaging revealed a Spontaneous pneumothorax complicating MT. The treatment combined anti-tuberculosis chemotherapy, chest drainage and respiratory physiotherapy. Outcome was favorable with improvement of clinical and radiological signs. Conclusion: Pneumothorax complicating MT requires a reflective diagnostic approach and rapid management to improve its prognosis.

Spontaneous Bilateral Pneumothorax in a Healthy Young Adult: A Comprehensive Case Report

Background: Spontaneous bilateral pneumothorax in healthy young adults is a rare and challenging condition that defies conventional diagnostic and etiological paradigms. This case report explores the presentation, diagnostic evaluation, management, and potential contributing factors in a 29-year-old male with no prior medical history who experienced bilateral spontaneous pneumothoraces. Aim: This case report aims to shed light on the complexities of managing spontaneous bilateral pneumothorax, particularly in the absence of common risk factors. It underscores the need for a thorough assessment and ongoing research to unravel the enigma surrounding this condition. Case Presentation: A healthy 29-year-old male presented with acute chest pain and shortness of breath, ultimately diagnosed with bilateral spontaneous pneumothoraces. Despite the absence of typical risk factors, advanced imaging techniques revealed valuable insights into the diagnosis and management of this unique presentation. Conclusion: Spontaneous bilateral pneumothorax in healthy individuals presents diagnostic challenges and raises questions about potential genetic predisposition, connective tissue disorders, and lifestyle-related triggers. While the acute phase was effectively managed, this case underscores the importance of interdisciplinary collaboration and ongoing research to comprehensively understand this condition.

Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax （PSP）. Methods： From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results： The average time of surgery was 49.0 rain （range, 33-65 rain）. No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients （93.75%） and moderate for two patients （6.25%）. No recurrences ofpneumothorax were observed at follow-up. Conclusions： The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.

Video-assisted thoracoscopic surgery (VATS) for bilateral primary spontaneous pneumothorax

目的将由帮助录像的 thoracoscopic 外科(大桶) 考察我们双边的主要自发的气胸(PSP ) 的治疗的经验。回顾的图表评论被在诊所上或电话会见跟随的材料和方法。病人们被在乎为由在四个医学中心的一位胸的外科医生或在北、中央的台湾的社区医院。有双边的 PSP 的 13 个病人从 1994 年 7 月同时或顺序经历了双边的大桶到 2005 年 12 月。结果与从 15 ～ 36 年(平均数 23.1 年)的年龄， 12 男性和男性女性同时为双边的 PSP 与大桶被对待，在双边的 pneumothoracis 的指示下面(n=4 ) 或顺序(n=9 ) 。在为非同时的 PSP 病人的第一和第二个相反地侧面的大桶过程之间的间隔从 7 d 到 6 年。13 个病人(84.6%) 中的十一个有突出的肺的 bullae/blebs，并且与机械或化学的 pleurodesis 经历了 bullae 切除术。吝啬的起作用的时间是( 45.6 ±1 8.3 ) min (范围 25 ～9 6 min )并且( 120.6 ±2 8.7 ) min (范围 84 ～1 66 min )分别地为非同时(为在第一个大桶以后的相反地侧面的方面的复发的第二个大桶)并且同时(双边的大桶在里面一操作)过程。没有手术后的死亡。然而，延长了漏气(】7 d ) 在在保守治疗以后恢复了的一个病人(7.7%) 发生了。胸试管排水的吝啬的持续时间是 3.1 d 并且中部在时期上面列在后面是 3.4 年。结论大桶是在双边的 PSP 的治疗的一个安全、有效的过程。因为甚至与可见 bullae，复发的发生不在我的组并且在某以前的文学那么高，双边的大桶仅仅与同时双边的 PSP 为病人被推荐。在一个仰卧的位置的双边的大桶应该仅仅在选择情况中被使用，因为可能的肋膜的粘附或在以后的方面上隐藏 bullae。

A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.

Simultaneous Bilateral Spontaneous Pneumothorax: Report of 6 Adult Patients

Background: Spontaneous pneumothorax (SP) refers to the spontaneous presence of air in the pleural sac(s) without iatrogenic or traumatic factors. The simultaneous bilateral SP (SBSP) is rare yet serious clinical condition which may pose a significant threat to patient’s life. Herein, 6 patients with SBSP managed in Sulaimaniyah Teaching Hospital (STH) over 6-year period (2006-2011) are reported with literature review. Methodology: A prospective clinical study. The diagnosis was made on clinical and radiographic grounds. The initial therapy was a bilateral tube thoracostomy (BTT) followed by chemical pleurodesis. Thoracotomy for excision of subpleural blebs or bullae and pleurectomy was performed for prolonged air leak (lasting >14 days). Results: There were 5 males (83.33%) and 1 female (16.67%) with a mean age of 34.8 years ranging between 20 and 50. All patients had presented with dyspnea and chest pain and were smokers. Three patients (50%) had primary (PSP) whereas the remaining had secondary (SSP) (chronic obstructive pulmonary disease—COPD, n = 2 and pneumonia, n = 1). None of the patients had recurrence. Unilateral thoracotomy was necessary in 5 patients (SSP, n = 3 and PSP, n = 2). Prolonged air leak was observed once postoperatively (16.7%) while mortality was nil. Conclusions: Prompt recognition of this rare yet potentially serious condition is crucial. The clinical diagnosis is straightforward with plain chest radiography being the most helpful workup. The initial therapy is via BTT followed by pleurodesis. Surgery is necessary for prolonged air leak and failure of the lung to expand.

An unusual cause of simultaneous bilateral spontaneous pneumothorax

INTRODUCTION Scrub typhus,a tropical febrile vector borne disease also known as"Tsutsugamushi disease",is caused by Orientia tsutsugamushi,a gram negative obligate intracellular slow growing bacteria.The infection is transmitted by the bite of larval stage(chiggers)mites belonging to the family Trombiculidae.The disease

FAMILIAL SPONTANEOUS PNEUMOTHORAX

it is believed that there are some factors related with familial spontaneous pneumothorax. These factors are hereditary,homologous leucocytic antigen (HLA),α-antrypsin (α-AT) and lanky somatotype,According to the analysis or 7 cases with the disease and references review, in this paper,we believe that the familial spontaneous pneumothorax is related with HLA,and α-AT,ut not every patient has this relation. The phenotype of HLA and α-AT can he passed on to next generation from either father or mother. It is also believed that the formation of spontaneous pneumothorax in this group is related with the maldevelopment of local lung and bronchiole rather than with the lanky somatotype.

Is There a Role for Chest Computed Tomography in Patients with Primary Spontaneous Pneumothorax?

Background: Primary spontaneous pneumothorax is a relatively common condition in young adults. Although blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they are very rarely the actual cause of the pneumothorax. Objective: To assess our experience with chest computed tomography evaluation in patients with recurrent spontaneous pneumothorax as compared to their histopathology findings. Study Design: A prospective study analysis. Materials and Methods: From January 2013 to December 2016, 38 consecutive patients with unilateral recurrent spontaneous pneumothorax underwent video-assisted thoracic surgery. Their chest computed tomography scans were reviewed and compared with their histopathology findings. Results: Thirty-six adult patients with unilateral recurrent spontaneous pneumothorax were included;their mean age was 33.9 years, and they all received video-assisted thoracic surgery and mechanical pleurodesis. Blebs or bullae were present in the chest computed tomography scans of fourteen patients (39%);of those fourteen patients, five (35.7%) had emphysematous changes in histopathology. Seventeen out of the thirty-six (47%) had no blebs or bullae in their chest computed tomography scans;of those seventeen patients, ten (59%) had emphysema like changes and seven (41%) had blebs in their histopathology studies. The remaining five patients (14%) had normal chest computed tomography scans. Conclusions: We conclude that preoperative chest computed tomography is not beneficial in every patient with recurrence of primary spontaneous pneumothorax.

Spontaneous Bilateral Pneumothorax with Recurrent Pneumothorax: A Case Report

Aim: To report a rare case of spontaneous bilateral pneumothorax with recurrent pneumothorax. Background: Spontaneous bilateral pneumothorax is medical and surgical emergency. It is presence of free air in the bilateral pleural spaces. It rarely occurs at any age but usually young age without apparent precipitating etiology in healthy subjects without any existing pathology. Case Report: In present case, a non smoker, uneducated, young housewife was received in emergency in critical condition and admitted in Intensive Care Unit directly, Peoples Medical university Hospital, Nawabshah, and Sindh, Pakistan. She felt difficulty in breath and after few moments she complained chest pain on right side of chest. They rushed in emergency in Peoples Medical University hospital and diagnosed as case of pneumothorax and at the same time her symptoms started worsening and she developed central cyanosis. In emergency chest X-ray was done showing bilateral pneumothorax, patient developed respiratory distress, emergency bilateral chest intubation was done and due to SO2 drop. Patient was kept on mechanical ventilation. After 24 hours she was weaned off and she was vitally in stable state and shifted in medical department and after 2 weeks she was discharged well. After 3 days of discharge she again came in emergency X-ray shown right sided recurrent pneumothorax, chest intubation done and she was referred to Oojha Institute of Chest Diseases, Karachi, Pakistan for further management and Pleurodesis. Conclusion: Bilateral spontaneous pneumothorax is medical and surgical emergency, diagnosis is thru clinical history, examination of chest and X-ray chest. Prompt diagnosis and management with chest intubation bilaterally and supportive treatment may decrease the morbidity in these critical cases.

Analysis of Recurrence and Influencing Factors of Spontaneous Pneumothorax After Thoracoscopic Surgery

This study was conducted to explore the factors that are influencing the recurrence of spontaneous pneumothorax after thoracoscopic surgery.Around 110 patients with spontaneous pneumothorax who underwent thoracoscopic bullectomy in Hebei Hospital from May 2017 to May 2021 were included in this study.The patients were divided into the recurrence group(15 cases)and the non-recurrence group(95 cases),and the influences of gender,age,smoking history,height,weight,operation time,the weight of the excised tissue,number of excised pulmonary bullae,postoperative chest tube maintenance time,duration of air leakage,and length of hospital stay on the recurrence of spontaneous pneumothorax after thoracoscopic surgery were investigated.This study found that the height/weight,operation time,duration of air leakage,number of pulmonary bullae removed,weight of the removed tissue,postoperative chest tube maintenance time,and duration of hospital stay in the recurrence group was 3.2±0.4,50.9±1.2,2.1±0.4,1.6±0.2,4.2±1.3,2.4±1.5 and 7.2±1.5,respectively.Meanwhile,the recurrence group was 2.6±0.3,50.8±1.3,1.3±0.2,1.8±0.9,4.4±1.2,4.1±1.7 and 6.9±1.6,respectively.After comparing the relevant factors between the recurrence group and the non-recurrence group,it was found that there was comparability between age,height/weight,duration of air leakage and postoperative chest tube maintenance time,where these factors were shown to affect the recurrence of spontaneous pneumothorax after thoracoscopic surgery,while gender,smoking,operation time,number of resected bullae,weight of resected tissue and length of hospital stay had no effect on recurrence after spontaneous pneumothoracoscopic surgery.In short,thoracoscopic bullectomy is the best clinical treatment for spontaneous pneumothorax,however the occurrence of recurrence of spontaneous pneumothorax after the operation,which is mainly influenced by the patient’s height/weight,postoperative air leakage duration,and chest tube maintenance time.Therefore,it is essential to pay attention to the surgical treatment of the patients,and fully identify the related factors of postoperative recurrence,thereby the follow-up clinical treatment can be carried out effectively.

Analyzing the CT Features of Primary Spontaneous Pneumothorax and Its Application Value

Objective:To explore the performance characteristics of CT examination in primary spontaneous pneumothorax(PSP)and the effect of pleurodesis on patients with PSP.Methods:Sixty-four patients with PSP,who received medical care in the Affiliated Hospital of Hebei University from January 2017 to December 2021,were selected as the research subjects,of which 40 were male and 24 were female patients.All 64 patients were examined by X-ray and CT;the density,enhancement,and morphology of the pneumothorax were observed and analyzed,and the classification of pneumothorax was done.Results:The clinical analysis of 64 patients with PSP showed that the number of cases with unilateral pneumothorax was 42,accounting for 65.63%,whereas the number of cases with bilateral pneumothorax was 22,accounting for 34.37%.Among the cases of unilateral pneumothorax,the number of cases with left pneumothorax was 26,accounting for 61.90%,whereas the proportion of cases with right pneumothorax was 38.10%.When examined by CT,the diagnostic coincidence rate of 64 patients with PSP was 73.44%;using X-ray examination,the diagnostic coincidence rate of 64 patients with PSP was 92.19%.Conclusion:The detection accuracy of CT is higher than that of X-ray examination,which may improve the treatment effect in PSP,ensure the accuracy of findings,and facilitate follow-up treatment as well as the effect of postoperative analysis.

Distinctive clinical features of spontaneous pneumoperitoneum in neonates: A retrospective analysis

BACKGROUND Spontaneous pneumoperitoneum(SP) without gastrointestinal perforation rarely occurs in neonates, with most SP cases being idiopathic. Although SP usually follows a benign clinical course with favorable prognosis, it can become lifethreatening in certain situations. In these cases, urgent surgical intervention may be required. Therefore, it may be difficult to decide when or how to perform prompt interventions.AIM To demonstrate the distinct clinical features of SP to guide appropriate management by comparing characteristics between SP and typical pneumoperitoneum secondary to gastrointestinal perforation.METHODS We retrospectively reviewed electronic medical records and identified 37 neonates with radiological evidence of pneumoperitoneum who were treated at our institution. Clinical variables were compared between neonates with SP without gastrointestinal perforation(Group A) and those with pneumoperitoneum secondary to gastrointestinal perforation(Group B). Clinical variables between groups were compared using Student’s t-test and the chi-square test. The risk factors related to mortality were examined using multi-logistic regression analysis.RESULTS Group A comprised 35.1%(13/37) of the patients. The frequency of persistent pulmonary hypertension(53.8%) and pneumothorax(46.2%) before the development of pneumoperitoneum was significantly higher in group A than in group B(P =0.004). Platelet count and partial pressure of arterial oxygen(PaO) were significantly lower in group A(P = 0.015 and 0.025, respectively). Overall mortality was significantly higher in group A than in group B(76.9% vs 16.7%, P = 0.001). Only preterm infants were significantly associated with high mortality(P = 0.041;odds ratio = 18.0). Accompaniment with persistent pulmonary hypertension and pneumothorax were also significantly high(P = 0.004) in group A, but these were not strongly associated with high mortality.CONCLUSION This study identified a higher mortality rate in patients with SP than that described in previous reports. Neonates with SP were more likely to have thrombocytopenia, pneumothorax, and persistent pulmonary hypertension. Prematurity was the most significant factor affecting mortality.

POTENT HYPOTENSIVE EFFECTS OF ORPHANIN FQ IN CONSCIOUS STROKE-PRONE SPONTANEOUSLY HYPERTENSIVE RATS

Orphanin FQ（OFQ） or nociceptin is a novel neuropeptide consisting of 17 amino acids. This peptide has a primary structure reminiscent of that of opioid peptide but exhibits an opposite effect to make animals hyperreactive. The effect of this new peptide on cardiovascular function are not completely known. The present study was conducted to investigate the effect of intravenous bolus injection of orphanin FQ on mean arterial blood presure （MABP） in conscious stroke-prone spontaneously hypertensive rats (SHRsp). Adult male SHRsp and Wistar normotensive rats （250～300 g body weight, 2. 5～3 months old） were used in this study. The MABP was measured in the conscious state by a tail-cuff method. In SHRsp model, intravenous bolus injection of orphanin FQ or Tyr1-orphanin FQ （0. 5 mg/kg） induced a prolonged and marked reduc- tion in MABP. The maximum changes in MABP were -30. 2±4. 2 mmHg by orphanin FQ and -28. 2± 4. 7 mmHg by Tyr1-orphanin FQ at 10 min after administration,and this effect lasted over 30 min. The Phe1→Tyr substitution in orphanin FQ was found to retain almost fully hypotensive activity. Pretreatment of SHRsp with naloxone-HCI（60 μg/kg）, 5 min before the injection of orphanin FQ, did not block the hy- potensive effect of orphanin FQ. Therefore, opioid receptors could not account for the hypotensive effect of orphanin FQ in SHRsp. In Wistar rats, intravenous bolus injection of the same dose of orphanin FQ did not cause a change in MABP. These observations suggest that orphanin FQ is a novel hypotensive peptide and may have some role in the regulation of blood pressure in SHRsp, rather than in normotensive rats. The ex-act underlying mechanisms are waiting to be clarified.

Post-Natal Spontaneous Resolution of a Congenital Pulmonary Airway Malformation in an Infant: Plain Radiographic and CT Manifestations

We present a case of a near-term infant who developed respiratory distress, shortly after birth. Chest X-ray showed a right sided tension pneumothorax (PTX) with a large air containing structure at the base of the right hemithorax. The pneumothorax was partially evacuated with needle aspiration at which time the patient became asymptomatic, despite a small residual pneumothorax. CT scan of the chest confirmed a multilocular air-filled structure within the right lower lobe, most likely consistent with a congenital pulmonary airway malformation (CPAM). Subsequently, there was spontaneous resolution of the PTX and CPAM prior to surgical intervention. This case illustrates post-natal spontaneous resolution of a CPAM, thus obviating the need for surgical removal.

自发性气胸单孔胸腔镜手术后肺部并发症预测模型的构建

目的:探讨自发性气胸单孔胸腔镜手术后肺部并发症预测模型的构建。方法:选取2021年5月至2022年5月行单孔胸腔镜手术的106例自发性气胸患者,根据术后是否发生肺部并发症将患者分为并发症组(n=22)与无并发症组(n=84)。对两组患者临床资料进行单因素与多因素分析,筛选出影响术后肺部并发症的危险因素,并构建列线图预测模型。结果:并发症组患者年龄、吸烟史、合并肺部疾病、胸膜粘连严重、肺大疱数量、术后24 h疼痛分级、术中出血量高于无并发症组,术前白蛋白水平低于无并发症组。多因素Logistic回归分析结果显示,年龄≥50岁(OR=1.240,95%CI=1.064~1.445)、合并肺部疾病(OR=26.154,95%CI=1.224~558.648)、胸膜粘连严重(OR=23.289,95%CI=2.940~184.520)、肺大疱数量>2个(OR=2.878,95%CI=1.787~4.633)是影响术后肺部并发症的独立危险因素(P<0.05)。根据以上危险因素建立预测模型预测术后肺部并发症的受试者工作特征曲线下面积为0.82(95%CI=0.756~0.874),敏感度与特异度分别为82.33%与65.47%。结论:年龄、合并肺部疾病、胸膜粘连严重、肺大疱数量是影响自发性气胸单孔胸腔镜手术后肺部并发症的独立危险因素,根据其构建的列线图预测模型对术后肺部并发症的发生风险具有较好的预测价值。

不同导管胸膜腔置管闭式引流治疗自发性气胸疗效比较

目的:比较不同导管胸膜腔置管闭式引流治疗自发性气胸疗效。方法:选取新乡市第一人民医院2018年9月至2023年9月收治的90例自发性气胸患者作为研究对象,应用随机数字表法将其分为三组,即中心静脉导管组、胸腔引流管组与三腔气囊导尿管组,各组均为30例。所有患者均采取胸膜腔置管闭式引流术进行治疗,三组患者分别采取中心静脉导管、胸腔引流管和三腔气囊导尿管进行引流。比较三组患者临床疗效,置管时疼痛发生率、置管时出血量、二次置管率与调整引流管率,平均切口大小、肺复张时间、置管时间、住院时间,术后疼痛程度,术后并发症发生情况。结果:胸腔引流管组和三腔气囊导尿管组的总有效率高于中心静脉导管组;中心静脉导管组和三腔气囊导尿管组患者置管时疼痛发生率、二次置管率与调整引流管率以及置管时出血量均明显低于胸腔引流管组;中心静脉导管组患者平均切口大小明显短于三腔气囊导尿管组和胸腔引流管组,且三腔气囊导尿管组短于胸腔引流管组;术后1 d、3 d、5 d,中心静脉导管组和三腔气囊导尿管组患者的视觉模拟评分法(VAS)评分明显低于胸腔引流管组,中心静脉导管组和三腔气囊导尿管组切口感染、肺水肿/皮下气肿、胸膜反应发生率明显低于胸腔引流管组;差异均具有统计学意义(P<0.05)。结论:采取胸腔引流管与三腔气囊导尿管进行胸膜腔置管闭式引流治疗自发性气胸疗效优于中心静脉导管,而应用中心静脉导管和三腔气囊导尿管患者置管时疼痛发生率较低,能够降低二次置管率、创伤性较低,降低术后疼痛程度,减少并发症发生率。

自发性气胸术后血清NPY SP PGE2水平变化及与复发的关系

目的:观察自发性气胸患者术后血清神经肽Y(NPY)、P物质(SP)、前列腺素E2(PGE2)变化,并探究其与术后复发关系。方法:选取2017年5月至2020年12月收治的自发性气胸患者80例(病例组),另选取同期50例健康体检者为对照组,患者均行单孔胸腔镜下肺大泡切除术。检测病例组术前、术后30d血清NPY、SP、PGE2水平变化,并与对照组比较;随访1年,统计患者术后复发情况,并采用单因素分析、多因素Logistic回归分析探究术后复发的影响因素;绘制受试者工作特征曲线(ROC曲线)探究术后血清NPY、SP、PGE2水平对患者复发预测价值。结果:病例组术后血清NPY、SP、PGE2水平较术前降低(P<0.05),且病例组术前血清NPY、SP、PGE2水平均高于对照组(P<0.05),术后血清SP、PGE2水平均高于对照组(P<0.05)。80例患者有11例复发,复发率13.75%;单因素分析显示,复发组与未复发组体重指数、术后吸烟、术后有无肺大泡遗漏、是否行胸膜固定术、术后是否持续漏气、术后血清SP、术后血清PGE2比较差异有统计学意义(P<0.05);多因素Logistic回归分析显示,术后吸烟、有肺大泡遗漏、持续漏气、血清SP、血清PGE2是自发性气胸术后复发的影响因素(P<0.05)。血清SP、PGE2预测患者复发的ROC曲线下面积分别为0.921、0.872(P<0.05),其中SP截断值为1.85μg/mL,敏感度、特异度分别为90.91%、85.51%,PGE2截断值为172.7pg/mL,敏感度、特异度分别为72.73%、92.75%。结论:自发性气胸患者血清NPY、SP、PGE2表达明显升高,而经手术治疗后血清NPY、SP、PGE2可明显降低,其中复发者术后血清SP、PGE2表达较未复发者明显升高,二者或许可作为自发性气胸术后复发的预测指标。

基于数据挖掘技术研究中医治疗自发性气胸的组方配伍规律

目的:研究中医治疗自发性气胸的组方用药规律,为临床治疗提供有益参考。方法:收集中国知网、维普中文期刊服务平台、万方数据库、中国生物医学数据库等4个数据库建库至2023年2月28日发表的中医治疗自发性气胸的相关文献,采用中医传承辅助平台V2.5统计用药频次、常用药对及药物组合,采用关联规则、改进的互信息法、复杂系统熵聚类分析对药物关联规则及核心药物组合进行分析,采用无监督的熵层次聚类进行新处方分析。结果:共筛选出符合条件的方剂187首,涉及中药237味,使用频次≥10的中药有甘草、黄芪、茯苓、五味子、白术等55味,主要由补虚药、化痰止咳平喘药、活血化瘀药、理气药、清热药及利水渗湿药组成;由关联规则分析得到白术-茯苓、甘草-茯苓、黄芪-当归、党参-黄芪、麦冬-甘草等24种高频药物组合,其中甘草、黄芪、茯苓、白术、五味子、当归等是关联网络的核心;熵聚类分析得到药物核心组合30个、潜在的新处方15个。结论:中医治疗自发性气胸围绕虚、痰、瘀、郁的特点,以益气护肺、祛痰止咳、活血化瘀、行气利水等为核心治法,体现了肺、肝、脾、肾同治及虚实兼顾的治疗思路。