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气胸管理的实用方法。

A Practical Approach to Pneumothorax Management.

作者信息

Fantin Alberto, Castaldo Nadia, Salvitti Simone, Crisafulli Ernesto, Sartori Giulia, Patrucco Filippo, Vailati Paolo, Morana Giuseppe, Patruno Vincenzo, Aujayeb Avinash

机构信息

Department of Pulmonology, Santa Maria della Misericordia University Hospital, Via Colugna, 33100, Udine, UD, Italy.

Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

出版信息

Pulm Ther. 2025 Jun;11(2):327-346. doi: 10.1007/s41030-025-00297-z. Epub 2025 Apr 29.

Abstract

Pneumothorax, defined by the presence of air in the pleural cavity, is a potentially life-threatening condition requiring prompt diagnosis and tailored management. Rapid and accurate diagnosis is primarily achieved through radiological imaging. Management strategies for pneumothorax vary according to severity and aetiology. Conservative care, involving vigilant observation and supplemental oxygen, is suitable for small, stable pneumothoraxes. Needle aspiration can be an effective first-line treatment, although it may fail in some instances, necessitating escalation. Ambulatory devices facilitate outpatient care and reduce the length of hospital stays. Chest drainage remains a cornerstone therapy. Indwelling pleural catheters may be implemented in selective cases. Endobronchial treatments, including valves and spigots, offer minimally invasive options for reducing the flow of air leaks. Medical thoracoscopy with talc poudrage provides both diagnostic and therapeutic benefits in patients unsuitable for surgery, while surgical intervention represents the gold standard for definitive treatment. Adjunctive interventions include talc slurry pleurodesis and autologous blood patch pleurodesis for patients unsuitable for surgery. Effective management necessitates individualized treatment plans, incorporating risk factor modification, pain management, and physiotherapy. This practical approach aims to update the reader on the treatment modalities that can be used in all forms of pneumothorax in clinical practice.

摘要

气胸是指胸膜腔内存在气体,是一种可能危及生命的疾病,需要及时诊断和针对性治疗。快速准确的诊断主要通过影像学检查来实现。气胸的治疗策略因严重程度和病因而异。保守治疗,包括密切观察和补充氧气,适用于小型、稳定的气胸。针吸术可以是一种有效的一线治疗方法,尽管在某些情况下可能失败,需要进一步治疗。门诊设备便于门诊治疗并缩短住院时间。胸腔闭式引流仍然是基础治疗方法。在某些选择性病例中可采用留置胸膜导管。支气管内治疗,包括瓣膜和栓子,为减少漏气提供了微创选择。对于不适合手术的患者,滑石粉喷洒的内科胸腔镜检查具有诊断和治疗双重益处,而手术干预是确定性治疗的金标准。辅助干预措施包括为不适合手术的患者进行滑石粉糊剂胸膜固定术和自体血贴片胸膜固定术。有效的治疗需要个性化的治疗方案,包括危险因素的调整、疼痛管理和物理治疗。这种实用方法旨在向读者介绍临床实践中可用于各种形式气胸的治疗方式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e1e/12102440/abb0626dc812/41030_2025_297_Fig1_HTML.jpg

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