天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (6): 639-641.doi: 10.11958/j.issn.0253-9896.2015.06.016

• 临床研究 • 上一篇    下一篇

自发性气胸患肺压缩形态对治疗方法选择的指导价值

张莹 1,2， 贾玮 2， 李月川 2， 李海娜 1   

  1. 1天津医科大学研究生院 （邮编 300070）； 2天津市胸科医院呼吸与危重症医学科
  • 收稿日期:2014-11-17 修回日期:2015-01-14 出版日期:2015-06-15 发布日期:2015-06-10
  • 通讯作者: 张莹 E-mail:03048@163.com

Guiding values of different lung compressed forms in spontaneous pneumothorax on the#br# choice of the treatment

ZHANG Ying1,2, JIA Wei2,LI Yuechuan2, LI Haina1   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China; 2 Department of Respiratory and Critical Care
    Medicine,Tianjin Chest Hospital
  • Received:2014-11-17 Revised:2015-01-14 Published:2015-06-15 Online:2015-06-10
  • Contact: Ying Zhang E-mail:03048@163.com

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摘要： 目的 探讨自发性气胸患肺压缩形态对治疗方法选择的指导价值。方法 依据胸部 X 线后前位平片所示的患肺压缩形态将 219 例自发性气胸患者分为外围型 （127 例）、 不规则型 （92 例） 2 组。观察患肺压缩形态与既往行胸腔闭式引流术次数、 胸腔闭式引流术 7 d 治愈率、 胸腔闭式引流术治愈时间及外科手术中所见胸膜粘连的关系。结果 行 0、 1 和≥2 次胸腔闭式引流术不规则型的发生率分别为 11.71%（13/111）、 57.89%（33/57）和 90.19%（46/51）， 不规则型的发生率随既往胸腔闭式引流次数的增加而升高 （χ2=96.339， P < 0.01）。外围型、 不规则型患者行胸腔闭式引流术分别治愈 94、 30 例， 不规则型胸腔闭式引流术 7 d 治愈率低于外围型[36.7%(11/30) vs 90.4%(85/94)，χ2=37.596， P < 0.01]， 胸腔闭式引流术治愈时间高于外围型[d： 10.10±4.87 vs 4.00±2.07， t=9.806， P < 0.01]。2 组有 95例行手术治疗， 不规则型胸膜粘连发生率高于外围型[91.9% （57/62）vs 18.2% （6/33）， χ2=52.445， P < 0.01]。结论 患
肺压缩形态为外围型的患者行胸腔闭式引流治疗成功率高， 为不规则型宜行外科手术治疗。

关键词: 自发性气胸, 患肺压缩形态, 胸腔闭式引流, 胸膜粘连, 外围型, 不规则型

Abstract: Objective To evaluate the guiding values of different lung compressed forms in the choice of the treatment of spontaneous pneumothorax. Methods Based on lung compressed forms on anterior-posterior chest X-ray , a total of 219 spontaneous pneumothorax patients were divided into the periphery shape group (n=127) and irregular shape group(n=92). We observe the relationship between lung compressed form with the times of previous closed thoracic drainage， the cure rate of closed chest drain at the 7th day， length that closed thoracic drainage cure pneumothorax and the incidences of the surgical pleural adhesion. Results We found that the incidence of irregular lung compression in 0, 1 and 2 times of receiving previous drainage were 11.71% (13/111), 57.89% (22/57) and 90.19% (46/51) respectively. Its incidence increased with the times of previous closed chest drain (χ2=96.339, P < 0.01). In total, 94 patients (85 of which were cured until the 7th day) and 30 patients (11 of which were cured until the 7th day) were cured using close chest drain in peripheral shape and irregular shape group. And the 7th day cure rate is lower in irregular group than that in the peripheral shape. [36.7%(11/30) vs 90.4%(85/94), χ2=37.596, P < 0.01]. What’ s more, patients in irregular group need longer time to cure pneumothorax than patients in peripheral shape did [d:10.1±4.87 vs 4.00±2.07, t=9.806, P<0.01]. Among the 95 patients who underwent surgical treatment in both groups, the incidence of pleural adhesion is higher in irregular shape group than that in peripheral shape group [91.9%（57/62） vs18.2%（6/33), χ2=52.445, P < 0.01]. Conclusion The 7th day cure rate in patients with peripheral shape lung compressed form is higher than patients in irregular lung compressed form using closed chest drain with fewer incidence of pleural adhesion and shorter cure time. Those with irregular lung compression is more appropriate for surgical treatment.

Key words: spontaneous pneumothorax, lung compressed form, closed thoracic drainage, pleural adhesion, peripheral
shape, irregular shape