自发性气胸的诊治策略课件.pptxVIP

袖手旁观 还是 动手插管—气胸诊疗的策略及细节;原发性自发性气胸好发于哪类人群？ 吸烟对气胸有无影响？怎样影响？ 在座各位有没读过中国气胸诊治指南？ 医源性气胸最常见于什么临床操作？ 何谓稳定型/不稳定型气胸？ 怀疑气胸拍胸片，吸气相还是呼气相？ 气胸压缩率如何估算？大量/小量？ ;氧疗为什么能够加快气胸的吸收？ 何谓“危险三角”/“安全三角”？ 胸腔闭式引流需要常规负压吸引吗？ 如何尽量避免皮下气肿的产生？ 拔除胸管前必须夹管吗？ 拔管应该在吸气末/呼气末？ 气胸痊愈者，多久可以坐飞机？;交通性;自发性;自发性气胸（spontaneous pneumothorax，SP）;吸烟对气胸的影响;医源性气胸（Iatrogenic pneumothorax）;稳定型气胸;胸片吸气相 or 呼气相？;气胸压缩率(%) =4.2+4.7×(A+B+C) A=胸腔顶到肺尖的距离 B=上部中点到肺的距离 C=下部中点到肺的距离 长度单位均为cm ;Standard erect chest x-rays in inspiration are recommended for the initial diagnosis of pneumothorax, rather than expiratory films. (A) CT scanning is recommended for uncertain or complex cases. (D) ;气胸的大小（size of pneumothorax）;气胸大小的估算法;左肺门高于右肺门;应重视临床症状;自发性气胸 如为双侧或血流动力学不稳定，即行胸腔插管;保守治疗;ACCP反对细针穿刺 found simple aspiration to be appropriate rarely in any clinical circumstance BTS推荐 Needle (14-16 G) aspiration is as effective as large-bore (20 F) chest drains and may be associated with reduced hospitalisation and length of stay. (A) Needle aspiration should not be repeated unless there were technical dif?culties. (B) Following failed NA, small-bore (14 F) chest drain insertion is recommended. (A) Large-bore chest drains are not needed for pneumothorax. (D) ;危险三角安全三角; BTS推荐 Suction should not be routinely employed. (B) Caution is required because of the risk of RPO. (B) High-volume low-pressure suction systems (-10~-20 cmH2O) are recommended. (C);气胸与皮下气肿;尽量避免皮下气肿;拔管前需常规夹管吗？;拔管在 吸气末 or 呼气末？;吸气末负压最大;;气胸与航空;Lippert HL, et al. Eur Resp J 1991.;小结与展望;Thanks