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.

Efficacy of autologous blood pleurodesis for spontaneous pneumothorax in severe COPD

Objective To compare the effect,safety and influence on lung function of autologous blood pleurodesis with talc pleurodesis in severe chronic obstructive pulmonary disease patients with spon- taneous pneumothorax. Methods 53 Patients with COPD complicated spontaneous pneumothorax were randomly divided into two groups ,28 cases of experimental group each took pleurodesis with 50ml autolo- gous elbow vein blood ,25 cases of control group each took 100 ml talc suspension by drainage tube. The effect, short-term complication, rate of pneumothorax recurrence at 1 year and influence on lung function of these two groups were compared. Results Chest pain or fever was observed in 1 and 7 patients in the au- tologus blood pleurodesis and talc pleurodesis groups, respectively. During follow up period, there were 4 and 5 patients relapse ipsilateral pneumothorax,3 and 5 patients died respectively. After 1 year, the lung function decreased lightly, there was no difference between before and after treatment after consideration of time factor. Conclusion Autologous blood pleurodesis can effective treat severe COPD patients with spontaneous pneumothorax, reduce the rate of adverse reaction, prevent recurrence of pneumothorax and have no influence on lung function.