中心静脉导管胸腔内置管术在胸腔积液排液中发生气胸的临床分析

目的探讨中心静脉导管胸腔内置管术进行胸腔积液引流排液与肺癌癌性胸腔积液发生气胸之间的关系。方法选择同期住院肺癌癌性胸腔积液患者182例,结核性胸膜炎患者188例,两组患者均做中心静脉导管胸腔内置管术进行胸腔积液引流,胸腔积液引流前后进行胸部X线检查,观察有无气胸。结果肺癌癌性胸腔积液患者182例,发生气胸17例,占9．34％;结核性胸膜炎患者188例,发生气胸2例,占1．06％。将两组患者的性别、年龄及气胸发生情况进行Logistic回归分析,结果显示疾病种类与气胸的发生有关,其中肺癌癌性胸腔积液组相对于结核性胸膜炎组,OR=0．089,P〈0．05,95％置信区间为（0．011,0．854）。结论肺癌癌性胸腔积液相对于结核性胸膜炎所致的胸腔积液在中心静脉导管胸腔内置管术进行胸腔积液引流排液过程中发生气胸的危险性更大,其可能原因为肺癌癌性胸腔积液在原有病理改变基础上胸腔积液排出使得肺表面失去支撑保护和（或）胸腔内压降低而导致气胸。

Clinical analysis of occurrence of pneumothorax in the application of central venous catheterization of pleural effusion

Objective To explore the relationship of occurrence of pneumothorax between the pleural effusion and malignant pleural effusion from lung cancer. Methods One hundred and eighty - two cases of malignant pleural effusion from lung cancer were selected as group one and 188 cases of tuberculous pleural effusion were selected as group two at the same time in the hospital, then central venous catheterization were done in the two groups to drain the pleural effusion. X - ray was taken to observe whether the pneumothorax occurs or not before and after the drainage. Results Pneumothorax occurred in 17 cases of 182 malignant pleural effusion from lung cancer, 9.34 percent, and occurred in 2 cases of 188 cases of tuberculous pleural effusion, 1.06 percent. According to sex, age and the occurrence of pneumothorax, logistic regression analysis was taken in the two groups. The results showed that the oc- currence of pneumothorax was related to the disease category. The ratio of the two groups OR value was 0. 089, P 〈 0.05, 95% confidence interval was （0.011,0.854）. Conclusions Malignant pleural ef- fusion from lung cancer has more dangerous in the occurrence of pneumothorax during the course of punc- ture compared with the other pleural effusion. The reasonable explanation may be that in the basis of orig- inal lesion, the loss of protection and （or） the reduce of the intrathoracic pressure caused pneumothorax after the pleural effusion were drained.