改良型穿刺置管对自发性气胸疗效及预后影响因素分析

目的分析改良型穿刺置管对自发性气胸的疗效及预后影响因素。 方法选取2015年4月—2016年2月在山东省菏泽市立医院胸外科接受治疗的82例自发性气胸患者，按照数字法随机分为观察组及对照组，每组41例。对照组患者给予常规粗管穿刺闭式引流治疗，观察组患者则行优化胸腔穿刺置管术治疗(一次优化操作可重复用于引流)，比较两组患者的术后疗效，并分析影响患者预后疗效的危险因素。 结果观察组治疗总有效率为87.8%(36/41)，显著高于对照组的68.3%(28/41)，差异也有统计学意义(P<0.005)。治疗3个月后，观察组复发率为4.9%(2/41)，显著低于对照组的22.0%(9/41)。观察组患者血气肿和纵隔气胸的发生率均显著低于对照组，差异均有统计学意义(4.9% vs 22.0%，P＝0.023；2.4% vs 19.5%，P＝0.013)。观察组患者住院时间和医疗费用均显著低于对照组，差异也有统计学意义(5.4±2.1)d vs (11.2±2.4)d，P<0.001；(1 845.2±112.3)元vs (2 746.4±135.6)元，P<0.001]。Logistic回归分析显示，患者预后疗效的影响因素主要是未使用优化胸腔穿刺置管(OR＝2.636，95% CI：0.254～11.186，P<0.001)。 结论优化胸腔穿刺置管术治疗自发性气胸疗效显著，且能有效降低复发率及并发症发生率，缩短住院时间，减轻患者经济负担。

The analysis of curative effect and prognosis of patients with spontaneous pneumothorax by thoracic puncture and intubation

ObjectiveTo analyze the curative effect and prognosis of patients with spontaneous pneumothorax by thoracic puncture and intubation. MethodsA total of 82 patients with spontaneous pneumothorax who underwent thoracic surgery at Heze Municipal Hospital of Shandong Province from April 2015 to February 2016 were randomly divided into observation group and control group, with 41 cases in each group. Patients in the control group were treated by closed drainage with conventional thick-tube puncture. Patients in the observation group underwent optimal thoracentesis and catheterization (one optimized operation can be repeated for drainage). The postoperative efficacy was compared between the two groups and the prognosis was analyzed. ResultsThe total effective rate in observation group was 87.8% (36/41), significantly higher than that in control group (68.3%, 28/41)(P<0.05). After 3 months of treatment, the recurrence rate in the observation group was 4.9% (2/41), which was significantly lower than that in the control group (22.0%, 9/41). The incidences of hematoma and pneumothorax in the observation group were significantly lower than those in the control group (4.9% vs 22.0%, P=0.023; 2.4% vs 19.5%, P=0.013). The hospitalization time and medical expenses in the observation group were significantly lower than those in the control group (5.4±2.1) d vs (11.2±2.4) d, P<0.001 vs (1 845.2 ± 112.3) vs ± 135.6] yuan, P<0.001]. Logistic regression analysis showed that the main influencing factors of prognosis were unused optimized thoracentesis (OR=2.636, 95% CI: 0.254-11.186, P<0.001). ConclusionsOptimization of thoracic puncture and intubation in the treatment of spontaneous pneumothorax has significant curative effect, and can effectively reduce the recurrence rate and incidence of complications, shorten hospital stay, reduce the economic burden of patients.