摘要
目的 确定凝血酶粘连术后自发性气胸 (SP)的复发率。方法 1 91例次 (1 84例 )SP分为 4个治疗组 ,A组 :33例次 (2 9例 )因肺萎陷 <2 0 % ,且无明显呼吸困难 ,予以观察治疗 ;B组 65例次 (63例 )仅安置胸导管行闭式引流 ;C组 :85例次 (84例 )均予以凝血酶粘连术治疗 ;D组 :8例均行胸廓切开术。C组经胸导管注入充分混合的凝血酶 50 0U +2 %利多卡因 5～ 1 0ml+NS 2 0ml,再用NS 1 0ml冲洗管腔 ,夹闭 2h ,如呼吸困难较重即刻放开引流管 ,变换体位 ,尤其须使药液流至肺尖部 ,再持续引流 ,待肺全复张 ,水封瓶无气泡溢出 ,2 4h后拔管。随访包括临床症状、体征及X线胸片 ,随访期平均 (3 .2± 1 .1 )年 ,随访率 97%。结果 不包括注药后持续漏气行手术治疗 8例及失访 6例 ,C组同侧SP复发率 6 .5 % ,明显低于A组 68% ,B组 37% (P均 <0 .0 5) ,而D组复发率为 0 (P >0 .0 5)。C组并发症 :发热 2例 ,胸部不适 6例 ,发生率 9% ,无一例死于气胸或治疗相关的并发症且全部患者均出院。结论 凝血酶粘连术治疗SP具有疗效高、副作用少、复发率低等优点 ,值得临床推广。
Objective To observe the recurrent rate of spontaneous pneumothorax(SP) after thrombin adhesion operation. Methods 191 cases were divided into four groups:group A,33 cases were observed for lung atrophy lack of 20% area without dyspnea;group B,65 cases were placed thorax catheter for closed outflux;group C,85 cases were treated with thrombin adhesion;group D,8 cases were performed thoracotomy.Cases in group C received mixed thrombin 500U and 2% lidocaine of 5～10ml plus NS 20ml,then 10ml NS was given to wash the thorax catheter,and closed it for 2 hours.If dyspnea were worse,catheter would be immediately opened and body position be changed,especially the medicine would be let to flow to the top of lung until lung reopen and no bubble in bottle.Clinical symptoms,signs and chest x-rays should be observed during follow-up period,the mean time of which was (3.2±1.1)years,the follow-up rate was 97%. Results Except for 2 cases operated for leakage air and 3 cases missed,the recurrent rate of group C was 6.5%,which was significantly lower than group A 68% and group B 37%,while group D 0%.The complications of group C were just as follows:2 cases with fever,6 cases with check uncomfortable. Conclusion Thrombin adhesion operation has much advantages,such as high efficiency,less side effect and lower recurrent rate.
出处
《中国煤炭工业医学杂志》
2004年第5期396-397,共2页
Chinese Journal of Coal Industry Medicine
