Vallee P, Sullivan M, Richardson H, Bivins B, Tomlanovich M
Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan 48202.
Ann Emerg Med. 1988 Sep;17(9):936-42. doi: 10.1016/s0196-0644(88)80676-0.
In a prospective investigation of isolated simple pneumothorax, the treatment of 35 patients with a total of 37 pneumothoraces was studied. A standardized sequential treatment approach was followed for evacuation of the pneumothorax and maintenance of lung reexpansion. The protocol involved catheter placement using a Seldinger technique, aspirations, and documentation of reexpansion by chest radiography and observation. Reaccumulation of air was treated with Heimlich valve attachment to the catheter at intrapleural pressure and further observation. Continued air leak following Heimlich valve attachment was treated with chest catheter suction using a Pleurovac at -20 cm H2O pressure. Chest tube thoracostomy was performed for continued failure of reexpansion. In 22 of the 37 pneumothoraces (59%) simple catheter aspiration maintained lung reexpansion without complications. In the remaining 15 pneumothoraces (41%), seven (47%) responded to Heimlich valve attachment, and three (20%) maintained expansion with chest catheter suction. Chest tube thoracotomy was required to maintain expansion in 33% (five) of those who failed catheter suction (14% of all pneumothoraces studied). Patients treated successfully with simple catheter aspiration were sent home. Patients requiring a Heimlich valve, chest catheter suction, or chest tube thoracostomy were hospitalized. Use of these catheter techniques resulted in lower cost and was associated with shorter hospitalizations than in chest tube thoracostomy. Our study suggests that sequential treatment of simple pneumothorax should be considered as a cost-effective and therapeutically successful alternative to immediate chest thoracostomy in selected cases.
在一项关于单纯性气胸的前瞻性研究中，对35例患者共37处气胸的治疗情况进行了研究。采用标准化的序贯治疗方法来排出气胸并维持肺复张。该方案包括使用Seldinger技术放置导管、抽气，并通过胸部X线摄影和观察记录肺复张情况。当胸腔内压力下空气再次积聚时，通过在导管上连接Heimlich瓣膜进行治疗，并进一步观察。在连接Heimlich瓣膜后仍持续漏气，则使用Pleurovac以-20 cm H2O的压力进行胸腔导管抽吸治疗。若肺持续无法复张，则进行胸腔闭式引流术。在37处气胸中，有22处（59%）通过单纯导管抽气维持了肺复张且无并发症。在其余15处气胸（41%）中，7处（47%）对连接Heimlich瓣膜有反应，3处（20%）通过胸腔导管抽吸维持了肺扩张。在那些导管抽吸失败的患者中，有33%（5例）需要进行胸腔闭式引流术以维持肺扩张（占所有研究气胸的14%）。通过单纯导管抽气成功治疗的患者被送回家。需要使用Heimlich瓣膜、胸腔导管抽吸或胸腔闭式引流术的患者则住院治疗。与胸腔闭式引流术相比，使用这些导管技术成本更低，住院时间更短。我们的研究表明，在某些特定情况下，单纯性气胸的序贯治疗应被视为一种经济有效且治疗成功的替代立即胸腔闭式引流术的方法。
