细管留置治疗自发性气胸的优势-东南大学学报医学版

细管留置治疗自发性气胸的优势

作者：许栋杨华

单位：苏州市中西医结合医院呼吸内科, 江苏苏州 215101

分类号：R561.4

出版年·卷·期（页码）：2016·35·第一期（97-101）

摘要：

目的:探讨细管留置治疗自发性气胸的优势。方法:根据治疗方法不同,将患者进行分组比较:(1)将中等量以上原发性气胸患者,分为细管置入+定时抽气与传统气胸针穿刺抽气两个治疗组,对比两组的治疗有效率、气胸闭合时间;(2)将大量原发性气胸患者,分为细管置入+持续负压吸引和传统胸管+闭式引流术两个治疗组,对比两组的治疗有效率、相关并发症、症状缓解时间、带管时间、住院时间。结果:(1)细管置入+定时抽气的治疗有效率(91.7%)较穿刺抽气组(70.0%)高(P=0.029),其气胸闭合时间[(4.56±0.70) d]与后者[(4.89±0.90) d]近似;(2)细管置入+持续负压吸引的平均住院时间[(5.64±0.62) d]较传统胸管闭式引流[(7.2±0.78) d]短(P<0.01),并发症发生率(2/25)较后者(8/23)少(P=0.022),但其平均症状缓解时间[(40.48±14.31) min]较后者[(20.48±7.4)min]长(P<0.01),两者治疗有效率(84% vs 91.3%)、平均带管时间[(4.88±0.55) d vs (5.21±0.77) d]近似。结论:对于中等量以上的自发性气胸均可采取细管留置,然后根据破口愈合情况,酌情考虑延迟抽气、间断抽气以及持续负压吸引。

Objective:To investigate the advantage of small-bore chest tube treatment for spontaneous pneumothorax(SP). Methods:According to different medical treatment, two different comparisons were made. Comparison A, stable patients with a moderate SP were divided into needle aspiration group and small-bore chest tube with manual aspiration group, the absorption time and the effectiveness were compared. Comparison B, stable patients with a large SP were divided into small-bore chest tube drainage in negative pressure group and traditional large-bore chest tube drainage group,the effectiveness, complication rate, remission time, drainage duration, and the length of stay were compared. Results:In comparison A, the success rate was 91.7%(33/36) in small-bore chest tube group,little higher than 70.0%(21/30) in needle aspiration group(P<0.05), and absorption time was (4.56±0.70) d in small-bore chest tube group, similar to (4.89±0.90) d in needle aspiration group. In comparison B, there was no significant difference between small-bore chest tube group and large-bore chest tube group in success rate(84% vs 91.3%, P>0.05) and drainage duration[(4.88±0.55) d vs (5.21±0.77) d, P>0.05]. Small-bore chest tube group has shorter length of stay[(5.64±0.62) d vs (7.2±0.78) d, P<0.01] and lower complication rate(8% vs 34.7%, P<0.05), but longer remission time[(40.48±14.31) min vs (20.48±7.4) min, P<0.01]. Conclusion:Small-bore chest tube can be used to treat all SP above middle-size, and delayed aspiration, needle aspiration or drainage in negative pressure can been chosen according to onset time and breach condition.

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