胸腔急癥气胸.pptVIP

胸腔急症~氣胸 1.氣胸( Pneumothorax):是氣體在胸腔內引起肺萎陷。若引起縱 隔偏移及壓迫到對側的肺稱之為高張性氣胸(tension pneumothorax)，常因使用的人工呼吸器壓力過大而引起，或是 肺氣腫的水泡、肺囊腫破裂而造成。 ? 胸腔外科~黃文傑醫師 ?診斷 :  i.理學檢查: 患側的呼吸音減弱，心音偏向對側。有時頸部有捻 髮音(crepitus)。  ii.胸部X光: 患側呈現高透光性，而且沒有支氣管的顯影。旁邊 或甚至對側的肺葉萎陷。縱隔及心臟向對側偏移。 治療 : 無症狀或僅有輕微的呼吸窘迫，可在病房作嚴密的看護，這種 單純性氣胸有三分之二在五至七天內自癒而無須手術。 若有嚴重的呼吸困難及高張性氣胸，則應立即採取行動。以靜 脈注射用之套管針，由前胸第二肋間或腋窩中線第五或第六 肋間插入，接上水下引流瓶，先解除呼吸困難。然後再改用 胸管插入，等肺完全擴張沒漏氣後24-48小時再拔除。 手術(肺氣泡切除術、肋膜沾粘術) Spontaneous Primary pneumothorax Secondary pneumothorax Airway and pulmonary disease (COPD, asthma) Interstitial disease (Pulmonary fibrosis) Infection ( TB..) Neoplastic Catamenial ( Endometriosis) Iatrogenic Post-Traumatic Early complication Prolonged air leakage Non re-expansion of the lung Bilaterality Hemothorax Tension Complete pneumothorax Potential hazard Occupational hazard Absence of medical facilities in isolated areas Associated single bulla Psychological Second Episode Ipsilateral recurrence Contralateral recurrence after a first pneumothorax Surgical indication for primary spontaneous pneumothorax 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