Markos J, McGonigle P, Phillips M J
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA.
Aust N Z J Med. 1990 Dec;20(6):775-81. doi: 10.1111/j.1445-5994.1990.tb00422.x.
To assess the efficacy of simple aspiration as a treatment for pneumothorax, 40 consecutive pneumothoraces (28 spontaneous, 12 iatrogenic, all estimated at greater than or equal to 20% collapse on visual inspection of the chest X-ray) in 38 symptomatic patients were treated initially by small-lumen catheter (SLC) aspiration. SLC aspiration avoided the need for large-lumen intercostal catheter (LIC) underwater drainage in 28 cases (70%)--20 of 28 spontaneous and eight of 12 iatrogenic pneumothoraces. Outcome was not predicted by clinical variables or pneumothorax size, whereas an initial aspirate volume of less than or equal to 4 L (n = 33) was predictable of success in 28 cases (85%). Minor local subcutaneous emphysema and vasovagal reactions were encountered infrequently but with similar frequency to LIC drainage. No episodes of re-expansion pulmonary oedema occurred. The results confirm previous reports of the efficacy of simple aspiration as a treatment for spontaneous or iatrogenic pneumothorax. Initial treatment by SLC aspiration is recommended for all but life-threatening presentations of pneumothorax. Although not encountered in this study, the potential risk of re-expansion pulmonary oedema suggests that patients should be observed closely for four hours after aspiration.
为评估单纯抽气治疗气胸的疗效，对38例有症状患者的40例连续性气胸（28例自发性气胸，12例医源性气胸，经胸部X线透视估计肺萎陷均≥20%）首先采用细腔导管（SLC）抽气治疗。SLC抽气使28例（70%）避免了大腔肋间导管（LIC）水封引流——28例自发性气胸中的20例和12例医源性气胸中的8例。临床变量和气胸大小不能预测结果，而初始抽气量≤4L（n=33）的患者中有28例（85%）可预测治疗成功。局部轻度皮下气肿和血管迷走神经反应很少见，但其发生频率与LIC引流相似。未发生复张性肺水肿。结果证实了以往关于单纯抽气治疗自发性或医源性气胸疗效的报道。除气胸危及生命的情况外，建议对所有气胸患者首先采用SLC抽气治疗。尽管本研究未遇到，但复张性肺水肿的潜在风险提示抽气后应密切观察患者4小时。
