Royal Stoke University Hospital, Stoke-on-Trent, UK
Sandwell and West Birmingham Hospitals, West Bromwich, UK.
Clin Med (Lond). 2019 Mar;19(2):163-168. doi: 10.7861/clinmedicine.19-2-163.
Management of primary spontaneous pneumothorax (PSP) depends on the symptoms and size of lung collapse. The British Thoracic Society recommends needle aspiration (NA) for all PSP requiring intervention, followed by intercostal drain (ICD) if NA fails. We compared the role of NA versus ICD as the first step in PSP with 'complete lung collapse'.This was a retrospective observational study of 877 consecutive pneumothorax episodes at University Hospitals of North Midlands, Stoke on Trent, UK. Chest X-ray (CXR) at presentation was reviewed to identify PSP with complete lung collapse. The primary outcome measure was successful lung re-inflation after initial intervention.Two-hundred and sixty-six PSP patients were identified; 69 had complete lung collapse on CXR of which 35 had NA and 34 had ICD. The ICD group had a significantly better immediate success compared with the NA group (62% versus 11%, odds ratio (OR) = 12.5, p<0.0001; after adjustment for potential confounders, OR increased to 26.4, p=0.0001) although long-term outcomes were comparable.There should be clear consensus on definition and management of complete lung collapse. PSP with complete lung collapse could be managed as a separate subgroup where ICD placement is considered to be the first intervention.
原发性自发性气胸（PSP）的管理取决于症状和肺萎陷的大小。英国胸科学会建议对所有需要干预的 PSP 进行针吸（NA），如果 NA 失败，则进行肋间引流（ICD）。我们比较了 NA 和 ICD 在“完全肺萎陷”的 PSP 中的第一步的作用。这是英国特伦特河畔斯托克的北米德兰兹大学医院对 877 例连续气胸发作的回顾性观察性研究。对入院时的胸部 X 线（CXR）进行了回顾，以确定具有完全肺萎陷的 PSP。主要结局指标是初始干预后肺再充气的成功。确定了 266 例 PSP 患者；69 例 CXR 显示完全肺萎陷，其中 35 例行 NA，34 例行 ICD。与 NA 组相比，ICD 组的即刻成功率明显更高（62%对 11%，比值比（OR）=12.5，p<0.0001；调整潜在混杂因素后，OR 增加至 26.4，p=0.0001），尽管长期结局相当。对于完全肺萎陷，应该就其定义和管理达成明确共识。完全肺萎陷的 PSP 可以作为一个单独的亚组进行管理，其中放置 ICD 被认为是第一个干预措施。
