负压吸引辅助自体血胸腔注射治疗顽固性气胸的有效性及安全性观察

目的观察负压吸引辅助下应用自体血胸腔注射治疗顽固性气胸的有效性及安全性。方法将146例顽固性气胸患者随机分为两组,均经胸腔闭式引流管行持续负压吸引,变换不同体位至患侧肺复张或基本复张;治疗组经引流管胸腔内注射自体血50～100 mL,对照组经引流管胸腔内注射5%葡萄糖100 mL加红霉素0.75～1 g。结果治疗组1次治疗成功67例,共治疗成功89例;对照组分别为29例及47例;两组1次治疗成功率、总成功率比较,P均<0.05。术后随访2 a,治疗组复发4例,对照组复发10例;两组复发率比较,P<0.05。治疗组出现轻微胸痛6例,剧烈胸痛0例,发热2例;对照组分别为24、11、9例。两组不良反应发生率比较,P<0.05。结论负压吸引辅助自体血胸腔注射治疗顽固性气胸疗效确切,不良反应少,气胸复发率低。     

红霉素胸腔注射联合胸腔小导管负压吸引治疗老年COPD合并顽固性气胸

目的探讨红霉素胸腔注射联合胸腔小导管负压吸引治疗老年COPD合并顽固性气胸的有效性及安全性。方法对35例老年COPD合并顽固性气胸的患者,采用胸腔小导管负压吸引,并胸腔内注入红霉素,观察其疗效及近期并发症。结果有效33例,有效率94.3%;并发症有胸痛28例（80.0%）、发热22例（62.9%）、意识障碍1例（2.9%）、心功能不全1例（2.9%）,均经临床处理后症状缓解。结论红霉素胸腔注射联合胸腔小导管负压吸引治疗老年COPD合并顽固性气胸,效果良好,并发症轻微,安全性好,值得推广应用。     

纤维支气管镜作胸腔镜检对难治性气胸病因的诊断和治疗价值

纤维支气管镜作胸腔镜检对难治性气胸病因的诊断和治疗价值汕头大学医学院第一附属医院内科（５１５０４１）陈潮钦吴洁文郑小河王少彬１材料和方法难治性气胸是指自发性气胸患者经胸腔闭式引流或加持续负压吸引超过２周漏气仍然存在者。本组２５例均为住院患者，男２３例...     

中心静脉导管闭式引流联合持续负压吸引治疗自发性气胸的疗效分析

目的探讨中心静脉导管闭式引流联合持续负压吸引治疗自发性气胸的临床疗效和安全性。方法采用单腔中心静脉导管对自发性气胸患者进行胸腔闭式引流联合持续负压吸引治疗,治疗组67例。对照组66例,行传统粗硅胶管闭式引流,观察临床疗效。结果治疗组总有效率100％,对照组总有效率98.5％,治疗组与对照组治疗自发性气胸临床疗效、肺复张时间相近,无显著性差异（P〉0.05）;但粗硅胶管行胸腔闭式引流治疗会延长住院时间,增加并发症。结论单腔中心静脉导管闭式引流联合持续负压吸引治疗自发性气胸是一种操作简便,临床疗效好,并发症少,住院时间短,住院费用少的治疗手段,值得临床推广应用。     

肺萎陷疗法治疗难治性气胸的临床观察

气胸是一种常见病、多发病,多数气胸经胸穿抽气、闭式引流或加用持续负压吸引可治愈。如用胸闭引流并持续负压吸引超过2周,仍未完全吸收,则称为难治性气胸。难治性气胸可行外科手术治疗,但治疗创伤、费用较大,部分难治性气胸患者选择继续内科保守治疗。我院采用肺萎陷疗法治疗难治性气胸已4年余,取得一定效果,现报道如下。1对象和方法1.1对象自2001年1月至2005年1月,我科共收治难治性气胸105例,男63例,女42例,平均年龄49·5岁。患者均为单侧气胸,肺压缩在35%~70%,经胸闭引流并持续负压吸引2周后仍未完全吸收,无心脏疾病、慢性阻塞性肺病,对…     

胸腔闭式引流加持续负压吸引结合中医治疗自发性气胸的疗效

目的探究胸腔闭式引流加持续负压吸引结合中医治疗自发性气胸的疗效。方法选取我院2015年5月~2016年2月收治的自发性气胸患者52例作为研究对象,随机分为观察组和对照组,各26例。对照组患者单纯采用传统的胸腔闭式引流来进行治疗,而观察组患者则采用胸腔闭式引流加持续负压吸引结合中医来进行治疗。对比两组患者的术后并发症发生率(胸腔积液、伤口感染以及肺部感染)。结果观察组患者的术后并发症发生率为11.54%,对照组患者的术后并发症发生率为38.46%,前者的数据明显优于后者的数据,差异有统计学意义(P0.05)。结论胸腔闭式引流加持续负压吸引结合中医治疗自发性气胸的疗效显著,值得推广和应用。     

高渗葡萄糖联合榄香烯乳注射液胸腔注射治疗难治性自发性气胸的临床观察

目的:探讨高渗葡萄糖联合榄香烯乳液行胸腔注射治疗难治性自发性气胸的临床疗效及安全性。方法:将70例难治性自发性气胸患者随机分为2组,治疗组30例,给予50%葡萄糖20 mL联合榄香烯乳液40~60 mL胸腔内注射,对照组40例给予50%葡萄糖20 mL胸腔内注射。2组患者均行胸腔闭式引流。结果:治疗组治疗总有效率和一次注药有效率均高于对照组(93.3%vs 57.5%,66.7%vs 32.5%,均P0.05);治疗组发热率明显高于对照组(70.0%vs 47.5%,P0.05),2组患者胸痛发生率差异无统计学意义(P0.05)。结论:高渗葡萄糖联合榄香烯乳液胸腔注射可有效治疗难治性自发性气胸。     

评估中心静脉引流加持续低负压吸引治疗自发性气胸的疗效

目的评估中心静脉引流加持续低负压吸引治疗自发性气胸的疗效。方法将随机抽取2009年1月—2010年6月的30例需进行胸腔闭式引流术治疗的自发性气胸患者分为治疗组（13例）与对照组（17例）,治疗组使用深静脉留置套管针行胸腔闭式引流术加持续低负压（0.5～1.5kPa）吸引治疗自发性气胸,对照组常规大导管治疗自发性气胸,对两组疗效、复张时间及并发症进行比较。结果治疗组的治愈率、有效率、无效率分别与对照组比较,差异均无统计学意义（P〉0.05）;治疗组肺复张天数（4.3±2.1）与对照组（6.7±2.8）比较,差异有统计学意义（P〈0.05）;两组并发症发生率分别为7.7%和41.2%,治疗组并发症发生率与对照组比较,差异有统计学意义（P〈0.05）。结论中心静脉引流加持续低负压吸引治疗自发性气胸创伤小,感染、发热、皮下气肿、胸痛、胸腔积液发生机会少,患者病痛小,易接受,疗效满意。     

红霉素治疗持续漏气难治性自发性气胸1例并文献复习

目的观察胸膜腔内注入红霉素治疗持续漏气的难治性自发性气胸的作用及安全性。方法红霉素1 g溶于50%GS 60 ml中注入患者胸膜腔内,使患侧胸膜腔粘连。结果红霉素胸腔注入治疗持续性漏气疗效确切,毒副反应小。结论红霉素胸腔注入是治疗持续漏气难治性自发性气胸的有效方法。     

细管负压吸引联合吹气球治疗老年难治性气胸1例

<正>气胸是气体进入胸膜腔造成的积气状态,常用的治疗方法有吸氧、胸膜腔穿刺抽气、胸腔闭式引流等。经持续肋间引流7 d后仍存在活动性漏气时称难治性气胸^[1]。近年来,细管胸腔闭式引流被临床广泛应用^[2],包括治疗难治性气胸^[3],但细管负压吸引联合吹气球训练治疗难治性气胸鲜见文献报道,现将我院收治的1例老年病人临床资料报道如下。1 临床资料病人,男,68岁,身高175 cm, 体质量45 kg, 因“反复左上胸痛3个月”     

Autologous "blood patch" pleurodesis for persistent pulmonary air leak.

A persistent pulmonary air leak, whether as a result of pulmonary surgery or as a result of a traumatic or spontaneous pneumothorax, is a difficult and frustrating problem to manage. Several therapies have been employed, including thoracotomy and repair of the air leak, prolonged tube thoracostomy suction, and chemical pleurodesis. We report two cases in which patients with a prolonged air leak who were not candidates for thoracotomy had immediate successful treatment with an autologous "blood patch" pleurodesis. An autologous blood patch pleurodesis is, in our limited experience, a simple, painless, inexpensive, and effective treatment for patients with a persistent pulmonary air leak.     

自身血胸膜粘连术治疗重度慢性阻塞性肺病并自发性气胸的疗效观察

目的 比较重度慢性阻塞性肺病（COPD）并自发性气胸患者自身血胸腔内注射胸膜粘连术与滑石粉胸膜粘连术的疗效、安全性及对肺功能的影响.方法 将53例COPD并自发性气胸患者随机分为两组,试验组28例,采用自身肘静脉血50ml胸腔内注射;对照组25例,应用滑石粉混悬剂100 ml胸腔内注射.比较两组的疗效、近期不良反应、1年内的复发率及对肺功能影响.结果 试验组1例在术后出现有胸部疼痛,对照组7例在术后有胸痛或是发热.试验组与对照组在随访期间分别有4例、5例同侧气胸复发,分别有3例、5例死亡.术后1年复查肺功能较前均有下降.两组复发率及死亡率比较差异无统计学意义（P＞0.05）.结论 自身血胸膜粘连术可以有效治疗重度COPD并自发性气胸,减少不良反应发生率,预防复发并且对肺功能无明显影响.     

Intractable pneumothorax successfully treated by talc slurry pleurodesis and video-assisted thoracoscopic surgery in a patient with idiopathic pulmonary fibrosis]

Pneumothorax associated with idiopathic pulmonary fibrosis (IPF) is intractable and often fatal because the patients are usually under a long-term steroid therapy, and are associated with severely impaired lung function. Further, pneumothorax itself recurs frequently, and acute exacerbation of IPF may develop after a surgical intervention. Here, we describe a case of intractable pneumothorax developed in a patient with IPF who was successfully treated with repeated talc pleurodesis combined with video-assisted thoracoscopic surgery under local anesthesia. A 67-year-old male with IPF who was under a long-term treatment with steroid, developed right-sided pneumothorax. A chest drainage tube was placed in the right pleural cavity, and repeated pleurodesis with minocycline or fibrinogen was challenged, but the outcome turned out to be unsuccessful. Then, talc slurry was applied repeatedly, resulting in a high-grade fever associated with reactive accumulation of pleural effusion. However, air leakage did not cease completely despite the eight-times pleurodesis with talc using 16 g in total. Finally, video-assisted thoracoscopic surgery under local anesthesia was undertaken and the pulmonary fistula was successfully closed.     

Pleurodesis using autologous blood plus OK-432 for intractable spontaneous pneumothorax with high surgical risk]

Air leakage persisted from the lung in three cases of spontaneous pneumothorax. Pleurodesis with autologous blood ended in failure. Autologous blood plus OK-432 was instilled into the thoracic cavity from the chest drainage tube. Air leakage was stopped without serious side effects and the chest tube was removed uneventfully. Although the long-term outcome of this treatment is not known, pleurodesis using autologous blood plus OK-432 may be an effective way of treatment for spontaneous pneumothorax in cases with high surgical risk.     

High efficacy of pleurodesis using OK-432 for controlling intractable pneumothorax associated with pulmonary lymphangioleiomyomatosis]

We evaluated the efficacy of pleurodesis using OK-432 (Picibanil) for the treatment of pneumothorax associated with pulmonary lymphangioleiomyomatosis (LAM). Seven episodes of pneumothorax in five patients with LAM were treated with pleurodesis using OK-432. First, all patients underwent tube thoracostomy drainage. After drainage, 5 or 10 KE of OK-432 was administered via the tube. If incomplete lung expansion or a continuous air leak occurred, an additional 5 KE of OK-432 was administered. Of the five patients, two developed pneumothorax for the first time and three had a history of previous pneumothorax. The mean total dose of OK-432 administered was 13.6 KE, and the mean period of tube drainage was 11 days. The only recurrence of ipsilateral pneumothorax after OK-432 pleurodesis was observed seven years and eight months later in association with chronic respiratory failure in one patient. This patient was successfully treated with repeated pleurodesis using OK-432 during mechanical ventilation, and no recurrence has developed in the eight years since then. The main side effects of the procedure with OK-432 were fever and chest pain, which were well controlled by non-steroidal anti-inflammatory drugs. The study concluded that pleurodesis with OK-432 was an effective and safe treatment for intractable and recurrent pneumothorax associated with LAM.     

Autologous blood pleurodesis for pneumothorax complicating graft-versus-host disease-related bronchiolitis obliterans

Bronchiolitis obliterans (BO) is a manifestation of chronic graft-versus-host disease (GVHD) after allogeneic haemopoietic stem cell transplantation. Complications associated with this include persistent air-leak syndromes such as pneumothorax. Many methods have been described for treating this condition, both surgical and nonsurgical. We describe an 8-year-old boy with acute lymphoblastic leukaemia complicated by chronic GVHD-related BO, and subsequent pneumothorax with persistent air leak, who was treated successfully with autologous blood pleurodesis.     

Analysis of factors predicting the application of chemical pleurodesis for pneumothorax: An observational study

Chemical pleurodesis is performed in pneumothorax patients to treat nonresolving air leakage or prevent recurrence. However, factors that might predict the need for chemical pleurodesis remain unknown. Therefore, this study investigated predictive factors for the application of chemical pleurodesis for pneumothorax.We retrospectively analyzed 401 adult pneumothorax patients who underwent chest tube drain insertion during hospitalization at Fukujuji Hospital from January 2016 to December 2020. The patients were divided into 3 groups: the pleurodesis group, comprising 89 patients treated with chemical pleurodesis; the nonpleurodesis group, comprising 206 patients treated without chemical pleurodesis; and the surgical group, comprising 106 patients treated surgically. Data for patients in the pleurodesis group were compared to those in the nonpleurodesis or surgical group, and a predictive score of the application of chemical pleurodesis for pneumothorax was developed.Compared with the nonpleurodesis group, in the pleurodesis group, patient age was higher (P < .001), emphysema (n = 33 (37.1%) vs 70 (34.0%), P = .045), and interstitial pneumonitis (n = 19 (21.3%) vs 19 (9.2%), P = .022) were more common causes, and chest tube suction was more common (n = 78 (87.96%) vs n = 123 (59.7%), P < .001). Similar results were found between the pleurodesis and surgical groups. We developed a score for predicting the application of chemical pleurodesis for pneumothorax, including the following factors: age ≥55 years; presence of emphysema and/or interstitial pneumonitis; and use of chest tube suction. The score for the pleurodesis group showed a high area under the receiver operating characteristic curve compared with that for the nonpleurodesis group (0.776 [95% confidence interval]: 0.725–0.827). With a score of 2 as the cutoff value, the sensitivity was 91.0% and the specificity was 52.4%. In a comparison between the pleurodesis and surgical groups, the predicting score showed the high AUC of 0.904 (95% confidence interval: 0.863–0.945).This study reveals predictive factors for the application of chemical pleurodesis and provides a predictive score including 3 factors.     

Management of pneumothorax in lymphangioleiomyomatosis: effects on recurrence and lung transplantation complications

STUDY OBJECTIVES: Pneumothorax is a common complication of lymphangioleiomyomatosis (LAM), and the optimal approach to its treatment and prevention is unknown. Chemical or surgical pleurodesis are often required to prevent recurrence. However, their efficacy in LAM is unclear, and whether they contribute to perioperative complications during lung transplantation is uncertain. SETTING: The LAM Foundation database of registered patients. DESIGN: A questionnaire was sent to all registered patients who had at least one pneumothorax to determine rates and patterns of recurrence and efficacy of interventions. A second questionnaire was sent to registered LAM patients who received a lung transplant.Patients or participants: Of 395 registered patients, 260 patients (66%) reported at least one pneumothorax during their lifetime, 193 of whom (74%) completed the questionnaire. Of the 85 lung transplant patients who were sent a separate questionnaire, 80 patients (94%) responded. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Of the 193 respondents to the pneumothorax questionnaire, data on 676 episodes of pneumothorax were collected. Eighty-two percent (158 of 193 patients) had their first pneumothorax prior to a diagnosis of LAM. One hundred forty patients (73%) had at least one additional pneumothorax, either an ipsilateral recurrence (99 of 140 patients, 71%) or a contralateral pneumothorax (104 of 140 patients, 74%). Recurrence rates were 66% after conservative therapy, 27% after chemical pleurodesis, and 32% after surgery. In patients who had undergone lung transplantation, prior chemical or surgical pleurodesis was performed in 45 of 80 patients (56%). Fourteen of 80 patients (18%) reported pleural-related postoperative bleeding, 13 of whom (93%) had prior pleurodesis. CONCLUSIONS: Chemical pleurodesis or surgery are equally effective and better than conservative therapy in preventing recurrence of pneumothorax in LAM. Due to the high recurrence rate, either procedure should be considered for the initial pneumothorax in these patients. However, both contribute to increased perioperative bleeding following lung transplantation, with no effect on length of hospital stay.     

Quantification of aspirated air volume reduces treatment time in pneumothorax

In 62 consecutive cases of pneumothorax, suction treatment was applied by a new method using a recently-developed vacuum pump (Pleupump) allowing the quantification of the volume of air through the chest drain. The previous 62 cases of pneumothorax treated with standard suction equipment were used as a control group. The new technique resulted in a statistically significant reduction in the mean suction treatment time from 8.1 to 4.8 days in patients with spontaneous pneumothorax. The mean total number of days in hospital was reduced from 10.0 to 6.5. This was accomplished without an increase in the number of complications or recurrences of the pneumothorax.     

肺癌合并肝硬化患者术后胸腔闭式引流观察和护理特点

目的通过对我科近4年中18例肺癌合并肝硬化患者术后胸腔闭式引流进行观察,探讨此类患者的护理特点。方法 18例患者术后3d每天均有500ml以上引流胸腔积液,有10例(A组)在术后3d仍有800ml胸腔积液,给予自体血胸膜固定术,8例(B组)仍予常规支持对症治疗,比较两组术后恢复时间和住院费用。结果 A组平均住院时间为26d,平均住院费用为4.1万元;B组平均住院时间为19d,平均住院费用为3.2万元,差异均有统计学意义(P<0.05)。结论肺癌合并肝硬化患者术后需加强观察胸腔积液的变化,及时的自体血胸膜固定术并加强指导翻身护理,可在临床上加快此类患者的康复,同时减少住院费用。