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。     

红霉素胸膜固定术对难治性胸膜疾病的治疗价值

目的探讨红霉素胸膜固定术对难治性胸膜疾病（恶性胸腔积液、复发性气胸）的治疗价值。方法经胸腔闭式引流管将红霉素0．75～1．0g溶于5％葡萄糖40ml溶液注入到胸膜腔治疗复发性气胸18例,恶性胸腔积液12例为治疗组,以同期14例复发性气胸,10例恶性胸腔积液用胸腔穿刺抽气、抽液和（或）胸腔闭式引流的治疗方法为对照组。结果以红霉素为硬化剂的胸膜固定术治疗30例难治性胸膜疾病均痊愈或好转出院,30例患者均随访,治疗组18例气胸中2例复发,复发率11．1％,较对照组43．3％差异有显著性（P〈0．05）。治疗组12例恶性胸腔积液0．5及1年生存率分别为100％、75％分别高于对照组的60％、20％,两者均有显著性差异（P〈0．05）。结论红霉素可作为一种有效的胸膜硬化剂治疗复发性气胸、恶性胸腔积液。     

两种胸膜固定术方法治疗老年性难治性自发性气胸的临床分析

目的探讨两种不同胸膜固定术在难治性老年性自发性气胸治疗中的临床价值。方法选取96例老年性难治性自发性气胸患者,作胸部CT或胸部D确诊后,作胸膜腔闭式引流术外接水封瓶引流2周,效果不佳。把病例随机分为两组,治疗组56例采取经胸膜腔闭式引流管局部注入50%葡萄糖40ML+无菌滑石粉膜治疗。对照组40例经胸膜腔闭式引流管局部注入50%葡萄糖治疗。观察气胸内气体吸收情况。结果治疗组有效率为96.4%(54/56),对照组有效率85%(34/40)。两组比较差异有显著性(P<0.05)。结论经胸膜腔闭式引流管局部注入50%葡萄糖+无菌滑石粉胸膜固定术治疗老年性难治性自发性气胸效果好。     

老年自发性气胸的外科治疗

目的 总结老年自发性气胸的外科治疗体会。方法 回顾性分析121例老年自发性气胸患者的诊治资料。结果 左倒气胸63例（52．1％），右侧气胸58例（47．9％）；气胸伴大疱型肺气肿表现者34例（28．1％），伴单纯肺气肿而无明显肺大疱者42例（34．7％），轻度肺气肿伴孤立肺大疱者21例（17．4％），轻度肺气肿伴多个肺大疱者9例（7．4％），无明显肺气肿伴肺大疱者15例（12．4％）；术后13例患者延迟拔除气管插管，余者顺利拔管；108例（89．3％）患者无漏气，10例（8．3％）曾出现Ⅰ度漏气，3例（2．5％）出现Ⅱ度漏气，经保守治疗后治愈。术后所有患者胸闷、气促症状较术前均明显改善，活动耐力增强。术后随访患者未见手术倒气胸复发。结论 老年自发性气胸的治疗应采取综合治疗方案，有手术条件者尽量选择手术治疗，术中要联合采用防止肺创面漏气以及促进胸膜腔粘连，预防气胸复发的措施，术后要重视病人的管理，采取各种措施促使肺复张。     

顺铂联合红霉素治疗恶性胸腔积液疗效观察

目的观察顺铂联合红霉索胸腔灌注治疗恶性胸腔积液的临床疗效和毒副反应。方法采用胸腔闭式引流术,胸液小于50ml／24小时引流,治疗组（22例）在胸腔注入顺铂60mg、红霉素1．0,对照组（20例）在胸腔注入顺铂60mg,每周1次,共1—3次。观察疗效、生活质量、生存率及毒副反应。结果治疗组有效率为85％显著高于对照组的50％（P〈0．05）,治疗组6个月复发率明显低于对照组,差异有显著性（P〈0．05）,两组治疗后Karnofsky评分明显提高,但两组差异无显著性（P〉0．05）,两组无严重不良反应,均可耐受。结论顺铂和红霉素联合胸膜腔内注射,消除胸水作用明显,值得临床推广。     

098滑石粉胸膜固定术治疗难治性自发性气胸

文献报告，自发性气胸的复发率为23％－50％，而第一次复发后的再复发率更高。自发性气胸的治疗目的是使肺迅速复张和永久性胸膜固定，其治疗方法尚不一致。无论是胸廓切开胸膜切除术或大瘤切除术，还是电视引导下经胸腔镜胸膜切除术或大疤切除术，创伤均较大，患者难以接受。作者报告用滑石粉胸膜固定术治疗难治性自发性气胸。方法1986、一必纳年间难治性自发性气胸89例。年龄中位数30．5（15－79）岁。难治性自发性气胸的定义为：①复发性自发性气胸；②持续性自发性气胸（插管弓l流7天后持续漏气）；③有严重肺部疾病的继发性自发性气胸…     

榄香烯乳注射液联合高渗葡萄糖胸腔注射治疗难治性自发性气胸的临床研究作者: 任先杰1 S谢俊刚2 S 杨正武3 S廖德英4

【】目的S探讨榄香烯乳液联合高渗葡萄糖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S按随机数字表法将70例难治性自发性气胸患者分为治疗组30例(使用榄香烯乳液40～60 ml联合20 ml 50％葡萄糖胸腔内注射),和对照组(20 ml 50％葡萄糖胸腔内注射)。两组患者均行胸腔闭式引流。结果S治疗组治疗总有效率为93.3%(28/30),一次注药有效率66.7%(20/30)；对照组治疗总有效率为57.5%(23/40),一次注药有效率32.5%(13/40),两组比较差异均有统计学意义(P<0.05)；治疗组发热率为70.0%(21/30)明显高于对照组47.5%(19/40)差异有统计学意义(P<0.05),两组患者胸痛发生率情况比较,差异无统计学意义(P>0.05)。结论S榄香烯乳液联合高渗葡萄糖胸腔注射可有效的治疗难治性自发性气胸。     

新鲜血浆加凝血酶胸腔内注入治疗老年顽固性气胸的疗效观察

目的观察新鲜血浆加凝血酶胸腔内注入治疗40例老年顽固性气胸的临床疗效。方法治疗组采用持续负压吸引后使引流切口处在胸廓最高位置，配同型新鲜血浆50ml及凝血酶1000U一次性注入胸膜腔并继续进行闭式引流，1周不愈者可进行2～3次。对照组连续负压吸引同治疗组，然后使用四环素粉（1g用50ml生理盐水溶解）一次性胸腔内注入，1周不愈者重复1次，可进行1～2次。结果治疗组气胸治愈率明显高于对照组，而不良反应方面比对照组少得多，经概率分析均P〈0．01，差异有显著统计学意义。结论胸腔内注入凝血酶加新鲜血浆治疗老年顽固性气胸，能使肺组织早日复张，治愈率高、复发率低、不良反应轻，值得临床推广应用。     

胸腔内滴注阿的平治疗复发性气胸或持续肺漏气

自1982年至1990年8月,用小剂量阿的平胸腔内注射治疗27例患者28例次复发性气胸或持续肺漏气,疗效良好.选择因手术或医源性造成持续肺漏气或复发性气胸的患者,经充分引流,漏气仍超过4天,将100mg阿的平盐酸盐溶于50ml 生理盐水中,经导管注入胸     

透明质酸钠对兔脓胸胸膜粘连及纤维化的影响

目的探讨透明质酸钠对兔脓胸胸膜粘连及纤维化的影响。方法20只雄性新西兰大白兔随机分为治疗组和对照组，每组10只。在右侧胸膜腔放置导管后，相继注入松节油和金黄色葡萄球菌以诱导脓胸形成，24h时抽取全部胸腔积液，脓胸被证实后，治疗组胸膜腔内注入透明质酸钠3ml（30mg），对照组注入生理盐水3ml。所有动物于24h后肌内注射青霉素20万U／d。96h时再次抽取胸腔积液，检测2次胸腔积液中的白细胞数、中性粒细胞比值、蛋白含量、葡萄糖浓度及pH值。第8天处死兔并开胸观察。结果每组各有9只兔完成实验，治疗组和对照组96h时胸腔积液中自细胞数分别为（25±13）×10^9／L和（37±10）×10^9／L，中性粒细胞比值分别为0．27±0．11和0．50±0．11，蛋白含量分别为（30±4）g／L和（36±4）g／L，治疗组均显著低于对照组，96h胸腔积液中治疗组葡萄糖浓度为（2．4±0．5）mmol／L，显著高于对照组的（3．8±1．3）mmol／L。治疗组和对照组胸膜粘连积分分别为（0．7±0．5）和（3．2±0．7）分，脏层胸膜厚度分别为（28±10）μm和（156±42）μm，成纤维细胞数分别为（37±15）个／mm^2和（163±58）个／mm^2，治疗组均明显少于对照组。结论早期胸膜腔内注入高分子量透明质酸钠可显著减轻兔脓胸胸膜粘连及纤维化，且安全性好。     

Video-assisted thoracoscopic surgery in the treatment of pneumothorax: 107 consecutive procedures

The aim of this prospective study was to evaluate video-assisted thoracoscopic surgery (VATS) in primary and secondary spontaneous pneumothoraces. Over a 37-month period, 107 videothoracoscopic interventions were performed to treat spontaneous pneumothorax in 105 patients, 78 men and 27 women, whose average age was 28 years.Indications for surgery included recurrent ipsilateral pneumothorax (47 cases), persistent air leak (23 cases), hypertensive pneumothorax (14 cases), history of contralateral pneumothorax (13 cases), and elective surgery (10 cases). All of these patients were treated by endoscopic resection of the bullae (or apical zone in cases where the suspected abnormalities, or bullae, could not be visualized) plus physical pleurodesis. There were no perioperative deaths. Complications occurred in 6% of the cases of primary spontaneous pneumothorax and in 45% of the cases of secondary spontaneous pneumothorax. The complications among the secondary pneumothorax patients ranged widely from postoperative subcutaneous emphysema (resolved through simple, unassisted observation) to the need for an accessory minithoracotomy. Two patients (1.8%) suffered a recurrence of pneumothorax 4 and 8 months, respectively, after VATS treatment.     

Air-leak syndromes in hematopoietic stem cell transplant recipients with chronic GVHD: high-resolution CT findings

OBJECTIVES: The purpose of this study was to determine the incidence and the high-resolution computed tomography findings of air-leak syndromes in a large group of hematopoietic stem cell (HSC) transplant recipients with proved chronic graft versus host disease (cGVHD). MATERIALS AND METHODS: High-resolution computed tomography scans of 9 allogeneic HSC transplant recipients (8 men, 1 woman; 19 to 45 years of age; median 28 y), with a proven diagnosis of cGVHD-related bronchiolitis obliterans syndrome (BOS) were reviewed for the presence, appearance, and distribution of abnormalities. RESULTS: Nine patients with cGVHD developed 10 episodes of spontaneous air-leak syndromes secondary to cGVHD-related BOS during the study period analyzed; for a 2-year estimated cumulative incidence of 2.1% (95% confidence interval 0.2% to 3.8%) its prevalence was 5.7% (95%CI: 2.6% to 10.5%). All cases were allogeneic HSC transplant recipients with cGVHD who acquired new respiratory symptoms and/or radiologic abnormalities. Pneumomediastinum and pneumothorax were present in 6 patients. Subcutaneous emphysema was identified in 3 patients and pulmonary interstitial emphysema in 2 patients. A combination of different air-leak syndromes was observed in 6 patients. CONCLUSION: Air-leak syndromes represent an uncommon late complication in HSC transplant recipients with cGVHD-related BOS.     

慢性阻塞性肺疾病并发自发性气胸的诊治分析

目的 探讨并分析慢性阻塞性肺疾病并发自发性气胸的临床诊断和治疗的方法.方法 回顾性分析2006年9月-2011年11月于我院就诊的140例慢性阻塞性肺疾病并发自发性气胸患者的临床资料,随机分为试验组80例和对照组60例,试验组采用水封瓶闭式引流或者抽气减压方法进行治疗,对照组采取卧床休息和吸氧等方式进行治疗.结果 试验组治疗总有效率为95.0%,对照组总有效率为85.0%,两组比较差异有统计学意义(P＜0.05).结论 慢性阻塞性肺疾病并发自发性气胸的病情较为严重,且误诊率和死亡率都较高,及时的诊断和治疗可以有效的降低死亡率.     

Factors related to primary bilateral spontaneous pneumothorax

OBJECTIVES: We studied the risk factors associated with primary bilateral spontaneous pneumothorax. METHODS: From January 2001 to December 2002, 102 patients with primary spontaneous pneumothorax were reviewed and divided into two groups. Group A patients had primary spontaneous bilateral pneumothorax (PSBP; simultaneous or nonsimultaneous). Group B included patients with a primary spontaneous pneumothorax (PSP). We compared age, smoking habits, body weight, height, body mass index (BMI), and radiological findings between groups. RESULTS: Twenty-four patients developed PSBP (24 %). The male-to-female ratio was 22 : 2 in group A and 73 : 5 in group B ( P = 0.106). Eleven group A patients (46 %) and 34 group B patients (44 %) were smokers ( P = 0.037). The mean BMI was 18.39 +/- 2.45 kg/m (2) in group A and 19.70 +/- 2.00 kg/m (2) in group B ( P = 0.009). High-resolution computed tomography revealed bilateral lung blebs or bullae in 63 % of group A patients and in 53 % of group B patients ( P = 0.724). CONCLUSION: PSBP was significantly more frequent in patients with a lower BMI and among smokers. These patients require extended hospitalization and vigilant treatment.     

Rifaximin improves survival in cirrhotic patients with refractory ascites: A real-world study

BACKGROUND Rifaximin has been shown to reduce the incidence of hepatic encephalopathy and other complications in patients with cirrhosis.However,few studies have investigated the effect of rifaximin in cirrhotic patients with refractory ascites.AIM To evaluate the effects of rifaximin in the treatment of refractory ascites and to preliminarily explore its possible mechanism.METHODS A total of 75 cirrhotic patients with refractory ascites were enrolled in the study(50 in a rifaximin and 25 in a control group).Patients in the rifaximin group were divided into two subgroups according to the presence of spontaneous bacterial peritonitis and treatment with or without other antibiotics(19 patients treated with rifaximin and 31 patients treated with rifaximin plus intravenous antibiotics).All patients received conventional treatment for refractory ascites,while patients in the rifaximin group received oral rifaximin-α200 mg four times daily for at least 2 wk.The ascites grade,fasting weight,liver and kidney function,and inflammatory factors in the plasma were evaluated before and after treatment.In addition,the gut microbiota was determined by metagenomics sequencing to analyse the changes in the characteristics of the gut microbiota before and after rifaximin treatment.The patients were followed for 6 mo.RESULTS Compared with the control group,the fasting weight of patients significantly decreased and the ascites significantly subsided after treatment with rifaximin(P=0.011 and 0.009,respectively).The 6-mo survival rate of patients in the rifaximin group was significantly higher than that in the control group(P=0.048).The concentration of interferon-inducible protein 10 decreased significantly in the rifaximin group compared with that in the control group(P=0.024).The abundance of Roseburia,Haemophilus,and Prevotella was significantly reduced after rifaximin treatment,while the abundance of Lachnospiraceae_noname,Subdoligranulum,and Dorea decreased and the abundance of Coprobacillus increased after treatment with rifaximin plus intravenous antibiotics.The gene expression of virulence factors was significantly reduced after treatment in both subgroups treated with rifaximin or rifaximin plus intravenous antibiotics.CONCLUSION Rifaximin mitigates ascites and improves survival of cirrhotic patients with refractory ascites.A possible mechanism is that rifaximin regulates the structure and function of intestinal bacteria,thus improving the systemic inflammatory state.     

老年自发性气胸的治疗体会

目的探讨老年自发性气胸的发病特点及治疗方法。方法对2003年至2007年4年间我科收治的老年自发性气胸84例进行回顾性分析并总结。结果老年自发性气胸多合并肺部基础疾病,起病急、憋喘重、需紧急处理,且带管时间长,大多需注入高渗糖等粘连剂愈合。结论老年自发性气胸临床表现不典型,易误诊,运用胸腔闭式引流加注入高渗糖,治愈率高,不良反应少,复发率低。     

胸腔镜治疗多发胸膜下肺大疱自发性气胸简

目的 探讨在自发性气胸电视胸腔镜手术治疗过程中以结扎速处理多发胸膜下肺大疱的可行性及疗效.方法 103例在电视胸腔镜手术中探查发现多发胸膜下肺大疱的自发性气胸患者分为两组,其中Ⅰ组采用低能量电凝治疗,Ⅱ组采用结扎速处理.结果 与Ⅰ组相比,Ⅱ组术后胸管留置时间显著缩短（P〈0.05）,两组患者手术时间、使用直线切割缝合器钉仓数目、术中出血、术后持续性肺漏气、术后住院时间以及术后复发,无明显差异（P〉0.05）.结论 在自发性气胸术中以结扎速处理多发散在胸膜下肺大疱疗效满意,值得推广.     

中心静脉导管治疗自发性气胸的临床观察

目的 比较中心静脉导管与粗硅胶管行胸腔闭式引流治疗自发性气胸的疗效及并发症.方法 我科收治的64例自发性气胸患者随机分治疗组和对照组,治疗组32例行中心静脉导管闭式引流接TFR型胸腔引流储液瓶3-1300加DY-1A型低压电动负压吸引器吸引;对照组32例行粗硅胶管接水封瓶闭式引流,观察两组疗效及并发症.结果 中心静脉导管组与粗硅胶管组疗效相近,差异无统计学意义,但粗硅胶管行闭式胸腔引流并发症多.结论 中心静脉导管闭式胸腔引流家负压吸引治疗自发性气胸是一种痛苦小,并发症少,操作简便,病人易接受的方法.     

早期排气与延迟排气对原发性自发性气胸疗效的差异比较

目的 探讨早期排气与延迟排气对原发性自发性气胸疗效的影响,并比较二者的近期疗效.方法 对1998年7月至2006年6月山东省潍坊市人民医院呼吸科就诊的264例原发性自发性气胸患者进行研究,分为早期排气组(142例)和延迟排气组(122例),分别于3 d内及第7天进行治疗,观察住院时间及治疗失败率等近期疗效,并随访2年观察气胸复发次数及胸膜粘连等远期疗效.结果 早期排气组住院时间为(18±6)d,延迟排气组为(6±2)d.早期排气组中气胸量20%～50%的患者51例,其中44例于第1次抽气后气胸最增加,改为胸腔插管引流;气胸最>50%的患者行插管引流91例,其中12例因持续漏气转入胸外科行手术治疗.延迟排气组122例中81例于第1次抽气时抽尽气体,其余41例初次抽气出现咳嗽或呼吸困难加重,于次日将气体伞部抽尽,均未发生气胸加重、复张性肺水肿或抽气失败.2年内随访例数243例,早期排气组随访128例,延迟排气组115例,结果显示延迟排气组复发5例,早期排气组复发29例,经外科手术者均未复发.早期排气组及延迟排气组分别有79例和0例X线胸片显示胸膜粘连,两者比较筹异有统计学意义(P<0.05).结论 临床十预时间的早晚可影响患者预后,延迟排气治疗对原发性自发性气胸患者可缩短住院时间,降低胸膜粘连及气胸复发率.