胸腔急症气胸.ppt

Spontaneous Pneumothorax-Definition Factors Definition Accumulation of intrapleural air as the result of a break in either the visceral or parietal pleura Factors determining gas reabsorption Diffusion properties of the gases Pressure gradients Area of contact Permeability of pleural surface Spontaneous Pneumothorax-Clinical investigation Signs and symptoms Sudden onset chest pain Shortness of breathing Cough Diagnosis CXR Auscultation Differential diagnosis Skin fold Giant bulla Treatment Options for Pneumothorax Observation Needle aspiration Percutaneous catheter to drainage Water seal Pleur-evac type Heimlich valve Tube thoracostomy Water seal Pleur-evac type Heimlich valve Tube thoracostomy with instillation of pleural irritant Video-assisted thoracoscopic surgery Thoracotomy Indications for Surgical Intervention Second episode Persistent air leakage for greater than 7-10 days First episode with unexpanded, “trapped” lung History of contralateral pneumothorax Bilateral pneumothorax Occupational risk (driver, airplane pilot, living ina remote area) Large bulla Large undrained hemothorax First episode in a patient with one lung First episode in a patient with severely compromised pulmonary function Recurrence of Primary Spontaneous Pneumothorax Therapy Recurrence (%) Expectant 30 Aspiration 20-50 Chest tube drainage 20-30 Pleurodesis (tetracycline) 25 Pleurodesis (talc) 7 Surgery 2 Complication of Pneumothorax Tension pneumothorax Re-expansion pulmonary edema Persistent air leak Hemothorax (less than 5%) Pneumomediastinum Removal of Chest Tube Indications No fluctuation in the fluid column of the tube (complete lung reexpansion or tube occlusion) Daily fluid drainage 100ml in 24 hours Air leakage has stopped Proper timing (controversy) Spontaneous pneumothorax after tube thoracostomy re