不同年龄人群自发性气胸的病因和治疗特点分析

目的探讨青年和中老年人群自发性气胸的病因和治疗特点。方法回顾性分析同济大学附属肺科医院急诊科收治的113例自发性气胸患者的发病基础、治疗时间、预后等情况。结果收治的自发性气胸人数占同期急诊人数（124／4538）2．7％，占同期急诊住院人数（113／805）14％。113例气胸中，手术治愈25例，胸腔闭式引流／胸膜黏连治愈83例，未愈出院5例。复发病例44例。年龄〈40岁的青年组共40例，平均年龄（24．25±6．63）岁，扁平胸27例。有明确发病诱因31例。临床症状以胸闷为主，25例胸CT提示肺大疱。胸腔闭式引流28例，平均引流时间（3．54±2．85）d。手术治疗12例。年龄≥40岁的中老年组患者共73例，平均年龄（65．78±13．79）岁，桶状胸57例。有明确发病诱因11例。临床症状以胸闷和咳嗽为主，胸腔闭式引流55例，平均引流时间（6．65±10．2）d。手术治疗13例，未愈5例。结论青年人群气胸的发生和扁平胸有关联，发病诱因明确；肺气肿是中老年气胸的主要病因。无法手术的中老年难治性气胸，是气胸临床治疗的难点。

Analysis of the cause and the therapeutic characteristic of spontaneous pneumothorax in different age groups

Objective To discuss the cause and therapeuuc cnaracteristic of spontaneous pneumothorax between youth group （group A）and middle-senile group （group B）. Methods Clinical characteristics including pathologic basis, treatment period and prognosis in 113 patients with spontaneous pneumothorax were reviewed in Shanghai Pulmonary Hospital. Results In 113 cases of pneumothorax, 25 patients were treated with operation, 83 patients with thoracic close drainage, and 5 patients were uncured, 44 patients with recrudescent. Group A （age〈40 years old） included 40 patients, average age 24.25±6.63 years. Twenty-seven cases with flat-chest wall. Inducement was found in 31 cases. The clinical manifestations included short of breath and chest pain. Twenty-eight patients were treated with thoracic close drainage, average drainage days being 3.54±2.85 d. Twelve patients were treated with operation. Group B （age ≥40 years old） included 73 patients with an average age of 65.78±13.79 years. Fifty-seven cases with tubbiness-chest wall. Inducement was found in 11 cases. The clinical manifestations included short of breath and cough. Fifty-five patients were treated with thoracic close drainage, average drainage days being 6.65±10.2 d. Thirteen patients were treated with operation and 5 patients were uncured. Conclusion The cause of spontaneous pneumothorax in group A involves in flat-chest. This kind of pneumothorax has confirmative inducement. Emphysema is a chief cause of spontaneous pneumothorax in group B. The treatment of uncured spontaneous pneumothorax in group B is a clinical nodus.