细导管排气减压治疗COPD并发气胸有效性的研究

发布时间：2018-10-08 17:29

【摘要】：目的：评价细导管排气减压治疗COPD并发不同类型气胸者的有效性。方法：选取COPD并发气胸的患者,采用前瞻性、开放性、单中心临床研究。被入选患者按入院时间的先后顺序分为两组：常规组和气体分析组。常规组选用标准引流管,气体分析组根据先后2次胸腔内气体分析的结果参照Light标准判定气胸的类型,并据此选择细导管抽气治疗或细导管与水封瓶相连行闭式引流术治疗。观察并记录两组24小时内、5天内患肺复张情况,及5天内引流管失效、脱出、出现皮下气肿的情况。结果： 2009年1月至2011年10月共128例符合下列入选标准的天津市胸科医院胸内科的COPD并发气胸住院患者,最终达到主要观察终点的112例。常规组57例其中10例患者在插管2h内患肺完全复张；余47例5天时33例患肺完全复张；脱管1例；皮下气肿5例；引流管失效2例。气体分析组55例其中12例患者置管2h内患肺完全复张；余43例5天时16例患肺完全复张；脱管5例；皮下气肿19例；引流管失效11例；43例中改为常规管引流排气的24例。二组患者应用不同管径的引流管在第24小时内,患肺复张率无显著性差异,P0.05；第5天时,患肺复张率有显著性差异P0.05；皮下气肿、引流管失效二种并发症的发生率均有显著性差异P0.05；脱管发生率无显著性差异P0.05。两组发生引流管失效的13例患者,经胸腔气体分压测定结果为：闭合性气胸的6例,经肋间置入细导管行抽气减压治疗；交通性气胸5例、张力性气胸2例均行肋间切开插入标准管闭式引流排气减压治疗。结论： 1、对于COPD并发气胸者,以抽气前后两次胸腔气体分析测定结果判定患者的气胸类型,据此采取恰当的排气方式,使治疗科学、个体化。 2、COPD并发的交通性、张力性气胸者,以中心静脉导管置入行排气减压,皮下气肿、脱管、引流管失效的发生率明显高于标准胸腔引流管。 3、COPD并发气胸者引流管失效、患肺仍未复张者,以胸腔气体分析测定结果,作为采取下一步排气方法的选择依据,使已经变为闭合性气胸的患者避免再次接受肋间切开插管的痛苦。
[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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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