关于对艾滋病毒和结核病高流行人群中小创伤性气胸进行保守治疗的观点：基于证据的文献综述

An argument for the conservative management of small traumatic pneumathoraces in populations with high prevalence of HIV and tuberculosis: an evidence-based review of the literature.

作者信息

Tebb Zachary D, Talley Brad, Macht Marlow, Richards David

出版信息

Int J Emerg Med. 2010 Aug 20;3(4):391-7. doi: 10.1007/s12245-010-0190-z.

DOI:10.1007/s12245-010-0190-z

PMID:21373311

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3047831/

Abstract

BACKGROUND

Traumatic pneumothoraces are common. Many are managed with tube thoracostomy. However, there is a high complication rate from chest tube placement, particularly in patients with HIV, TB, or both.

AIMS

We sought to investigate the literature on the conservative management of traumatic pneumothorax in patients with HIV and/or TB.

METHODS

The literature search was broken into two parts. In the first part, we searched for articles comparing tube thoracostomy versus conservative management in traumatic pneumothorax. In the second part, we sought articles describing the incidence and outcome of pneumothoraces in patients with pre-existing HIV or tuberculosis. In both, relevant articles were reviewed, and citations were hand-searched.

RESULTS

For the first portion, we identified 384 papers. From these, six studies were relevant. For the second portion, we identified 327 articles. A total of four unique articles were selected. The heterogeneity of the studies did not allow any pooled analysis. The studies of conservative management demonstrated a low percentage of patients with small pneumothoraces (most often <1.5 cm or less than 10%) later required tube thoracostomy for clinical deterioration (range 6-25%). No studies focused exclusively on pneumothoraces in patients with TB. In patients with HIV, there were no prospective trials of conservative management. Mortality for all HIV-infected patients with pneumothorax was high (25-50%), and the rate of complications from tube thoracostomy was also high. Pneumocystits carinii pneumonia (PCP) independently increased mortality.

CONCLUSIONS

A review of the literature suggests that selected small pneumothoraces may be managed conservatively and that there is a high rate of complications related to tube thoracostomy in HIV patients. We propose a trial of the safety of conservative management of traumatic pneumothoraces in an area with a high prevalence of HIV and TB.

摘要

背景

创伤性气胸很常见。许多患者采用胸腔闭式引流术进行治疗。然而，胸腔置管的并发症发生率很高，尤其是在感染HIV、结核病或同时感染这两种疾病的患者中。

目的

我们试图研究关于HIV和/或结核病患者创伤性气胸保守治疗的文献。

方法

文献检索分为两部分。第一部分，我们搜索比较创伤性气胸胸腔闭式引流术与保守治疗的文章。第二部分，我们查找描述已有HIV或结核病患者气胸的发生率和转归的文章。在这两部分检索中，对相关文章进行了综述，并人工检索了参考文献。

结果

对于第一部分，我们识别出384篇论文。其中，6项研究相关。对于第二部分，我们识别出327篇文章。总共挑选出4篇独特的文章。研究的异质性不允许进行任何汇总分析。保守治疗的研究表明，小气胸患者（大多数情况下<1.5 cm或小于10%）中，因临床病情恶化而需要进行胸腔闭式引流术的比例较低（范围为6%-25%）。没有研究专门关注结核病患者的气胸情况。在HIV患者中，没有保守治疗的前瞻性试验。所有感染HIV的气胸患者死亡率很高（25%-50%），胸腔闭式引流术的并发症发生率也很高。卡氏肺孢子虫肺炎（PCP）独立增加死亡率。