胸腔急症气胸.pptVIP

胸腔急症气胸

?診斷:

i.理學檢查:患側旳呼吸音減弱，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，而且沒有支氣管旳顯影。旁邊或甚至對側旳肺葉萎陷。縱隔及心臟向對側偏移。治療:無症狀或僅有輕微旳呼吸窘迫，可在病房作嚴密旳看護，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。若有嚴重旳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)

SpontaneousPrimarypneumothoraxSecondarypneumothoraxAirwayandpulmonarydisease(COPD,asthma)Interstitialdisease(Pulmonaryfibrosis)Infection(TB..)NeoplasticCatamenial(Endometriosis)IatrogenicPost-Traumatic

Surgicalindicationforprimaryspontaneouspneumothorax

SpontaneousPneumothorax

-DefinitionFactors

SpontaneousPneumothorax

-ClinicalinvestigationSignsandsymptomsSuddenonsetchestpainShortnessofbreathingCoughDiagnosisCXRAuscultationDifferentialdiagnosisSkinfoldGiantbulla

TreatmentOptionsforPneumothorax

IndicationsforSurgicalInterventionSecondepisodePersistentairleakageforgreaterthan7-10daysFirstepisodewithunexpanded,“trapped”lungHistoryofcontralateralpneumothoraxBilateralpneumothoraxOccupationalrisk(driver,airplanepilot,livinginaremotearea)LargebullaLargeundrainedhemothoraxFirstepisodeinapatientwithonelungFirstepisodeinapatientwithseverelycompromisedpulmonaryfunction

RecurrenceofPrimarySpontaneousPneumothorax

ComplicationofPneumothoraxTensionpneumothoraxRe-expansionpulmonaryedemaPersistentairleakHemothorax(lessthan5%)Pneumomediastinum

RemovalofChestTube

TubeThoracostomy(ChestIntubation)

IndicationofChestIntubationDrainpleuralfluidorairpromotelungexpansion1.Pneumothorax2.Hydrothorax3.Hemothorax4.Chylothorax5.Pyothorax6.Post-thoracotomyetc.

ApparatusofChestTubeDrainage1.Underwatersealedbottle:Separatefromatmosphere2.Collectingbottle:Decreaseresistance