發(fā)布時(shí)間：2018-10-08 17:29

【摘要】：目的： 評(píng)價(jià)細(xì)導(dǎo)管排氣減壓治療COPD并發(fā)不同類型氣胸者的有效性。 方法： 選取COPD并發(fā)氣胸的患者,采用前瞻性、開放性、單中心臨床研究。被入選患者按入院時(shí)間的先后順序分為兩組：常規(guī)組和氣體分析組。常規(guī)組選用標(biāo)準(zhǔn)引流管,氣體分析組根據(jù)先后2次胸腔內(nèi)氣體分析的結(jié)果參照Light標(biāo)準(zhǔn)判定氣胸的類型,并據(jù)此選擇細(xì)導(dǎo)管抽氣治療或細(xì)導(dǎo)管與水封瓶相連行閉式引流術(shù)治療。觀察并記錄兩組24小時(shí)內(nèi)、5天內(nèi)患肺復(fù)張情況,及5天內(nèi)引流管失效、脫出、出現(xiàn)皮下氣腫的情況。 結(jié)果： 2009年1月至2011年10月共128例符合下列入選標(biāo)準(zhǔn)的天津市胸科醫(yī)院胸內(nèi)科的COPD并發(fā)氣胸住院患者,最終達(dá)到主要觀察終點(diǎn)的112例。常規(guī)組57例其中10例患者在插管2h內(nèi)患肺完全復(fù)張；余47例5天時(shí)33例患肺完全復(fù)張；脫管1例；皮下氣腫5例；引流管失效2例。氣體分析組55例其中12例患者置管2h內(nèi)患肺完全復(fù)張；余43例5天時(shí)16例患肺完全復(fù)張；脫管5例；皮下氣腫19例；引流管失效11例；43例中改為常規(guī)管引流排氣的24例。二組患者應(yīng)用不同管徑的引流管在第24小時(shí)內(nèi),患肺復(fù)張率無顯著性差異,P0.05；第5天時(shí),患肺復(fù)張率有顯著性差異P0.05；皮下氣腫、引流管失效二種并發(fā)癥的發(fā)生率均有顯著性差異P0.05；脫管發(fā)生率無顯著性差異P0.05。兩組發(fā)生引流管失效的13例患者,經(jīng)胸腔氣體分壓測(cè)定結(jié)果為：閉合性氣胸的6例,經(jīng)肋間置入細(xì)導(dǎo)管行抽氣減壓治療；交通性氣胸5例、張力性氣胸2例均行肋間切開插入標(biāo)準(zhǔn)管閉式引流排氣減壓治療。 結(jié)論： 1、對(duì)于COPD并發(fā)氣胸者,以抽氣前后兩次胸腔氣體分析測(cè)定結(jié)果判定患者的氣胸類型,據(jù)此采取恰當(dāng)?shù)呐艢夥绞?使治療科學(xué)、個(gè)體化。 2、COPD并發(fā)的交通性、張力性氣胸者,以中心靜脈導(dǎo)管置入行排氣減壓,皮下氣腫、脫管、引流管失效的發(fā)生率明顯高于標(biāo)準(zhǔn)胸腔引流管。 3、COPD并發(fā)氣胸者引流管失效、患肺仍未復(fù)張者,以胸腔氣體分析測(cè)定結(jié)果,作為采取下一步排氣方法的選擇依據(jù),使已經(jīng)變?yōu)殚]合性氣胸的患者避免再次接受肋間切開插管的痛苦。
[Abstract]:Objective: to evaluate the effectiveness of fine duct exhaust decompression in patients with COPD complicated with different types of pneumothorax. Methods: prospective, open and single-center clinical study was performed in patients with COPD complicated with pneumothorax. The selected patients were divided into two groups according to the time of admission: the routine group and the gas analysis group. The standard drainage tube was used in the routine group, and the type of pneumothorax in the gas analysis group was determined according to the Light standard according to the results of the gas analysis two times successively. To observe and record the reexpansion of lung in 24 hours and 5 days, and the failure of drainage tube and the occurrence of subcutaneous emphysema in 5 days. Results: from January 2009 to October 2011, a total of 128 COPD patients with pneumothorax from Department of Thoracic Medicine, Tianjin chest Hospital, who met the following criteria, finally reached the main observation end point. In the routine group, 10 cases suffered from complete reopening of lung within 2 hours after intubation, 33 cases of the remaining 47 cases suffered from complete reexpansion of lung at 5 days, 1 case was detachable, 5 cases were subcutaneous emphysema, and 2 cases were failure of drainage tube. In the gas analysis group, there were 12 cases with complete reexpansion of lung within 2 hours after tube placement, 16 cases with complete reexpansion of lung at 5 days in the remaining 43 cases, 5 cases with extubation, 19 cases with subcutaneous emphysema, and 43 cases with drainage tube failure. There was no significant difference in the rate of pulmonary retension between the two groups within 24 hours after the use of drainage tubes of different diameters (P0.05), and at the 5th day, there was a significant difference (P0.05) in the rate of pulmonary retension.Subcutaneous emphysema was found in the patients with subcutaneous emphysema. There was significant difference in the incidence of two kinds of complications of drainage tube failure (P0.05), but there was no significant difference in the incidence of extubation (P0.05). In the two groups of 13 patients with tube failure, the results were as follows: 6 cases with closed pneumothorax, 5 cases with communicating pneumothorax, 6 cases with closed pneumothorax, 5 cases with communicating pneumothorax, 6 cases with closed pneumothorax, and 5 cases with transthoracic pneumothorax. Two cases of tension pneumothorax were treated with intercostal incision and standard tube closed drainage and exhaust decompression. Conclusion: 1. For COPD patients with pneumothorax, the pneumothorax type was determined by the results of two chest gas analysis before and after air extraction, and the appropriate exhaust method was adopted to make the treatment scientific and individualized. 2in patients with COPD complicated by communication and tension pneumothorax, the incidence of exhaust decompression, subcutaneous emphysema, extubation and failure of drainage tube was significantly higher than that of standard thoracic drainage tube. (3) in COPD complicated with pneumothorax, the drainage tube failed, and the lung was still not retensioned. The results of chest gas analysis were used as the basis for the selection of the next exhaust method. To avoid the pain of intercostal incision and intubation in patients who have become closed pneumothorax.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.9

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