15.2016英文气胸课件-许瑞.pptxVIP

pneumothorax;anatomical?structure(解剖结构); a hermetic cavity(密闭) no air 3 ～15ml liquids a negative?pressure (呼气末-5~-3mmHg； 吸气末-10~-5mmHg);;The failure of respiration;;1. According to the pathogenesis;The fracture of visceral?pleura;2、 clinical classification （★重点掌握） ;闭合性气胸 Closure pneumothorax;;张力性气胸;临床分类比较;临床表现（clinical?manifestation）;The degree of dyspnea depends on呼吸困难的程度取决于：;Case 1 ; An old man with COPD Sever dyspnea， Orthopnea，cyanosis，RR: 40~50 /min Need oxygen?therapy? Chest CT ;Clinical sign;Radiology test;Radiology test;Diagnosis and differential diagnosis; AECOPD and Asthma： 1）Patients with AECOPD or acute exacerbation of asthma can also have the syndromes of dyspnea. 2）Differential?points: Post history, recurrent?short of breath, allergen Acute?myocardial?infarction 1）History， angina，Physical examination no pulmonary signs 2）ECG、 Myocardial enzymes pulmonary embolism high risk factor of DVT 、D-dimer、CTPA;Treatments (★重点掌握);Conservative treatment保守治疗;Air exhausting 排气治疗; Thoracentesis Indication: lung?collapse 10%，Patient without dyspnea，Closure pneumothrax; emergency for tension pneumothorax Location： midclavicular?line, 2nd ICSVolume： ＜1000ml for the 1st time;Indication： poor effect after thoracentesis Tension/Unclosue pneumothrax hemopneumothorax Recurrent pneumothorax Some closure pneumothorax with severe symptom ;;Indication for extubation(拔管指征)：Air bubbles never appear in the water-sealed bottle from thoracic tube. After 1-2 days reexamine the chest X-ray and determine the fully re-expansion of lung. (未见气泡冒出1~2天后，症状好转，呼吸音恢复，经透视或胸片证实肺已复张) 如无气泡冒出，患者症状缓解不明显，应考虑为导管不通畅，或部分滑出胸膜腔，需及时更换导管或其他处理。 ;Pleurodesis（胸膜固定术）;Surgery;Complication; ;谢谢！