Wait M A, Dal Nogare A R
Department of Surgery, University of Texas Southwestern Medical Center at Dallas 75235.
Chest. 1994 Sep;106(3):693-6. doi: 10.1378/chest.106.3.693.
Spontaneous pneumothorax (SP) secondary to the acquired immunodeficiency syndrome (AIDS) emerged in the decade of the 1980s. It has become an increasingly difficult condition to treat successfully both for the pulmonary internist and the surgeon. AIDS-related SP is complicated by a virulent form of necrotizing subpleural necrosis that results in diffuse air leaks that are refractory to the standard, traditional forms of therapy which enjoy good success for SP related to classic subpleural bleb disease. AIDS-related SP carries a high mortality rate despite treatment, independent of the development of primary respiratory failure. In reviewing our experience of 46 patients from a single institution treated over the past 10 years, we found that due to the high primary and secondary treatment failure rates, an aggressive stepped-care management of large-bore intercostal tube drainage, chemical pleurodesis, and early video-assisted talc poudrage is recommended in an attempt to shorten the duration of hospital stay, hospital costs, and mortality.
继发于获得性免疫缺陷综合征（AIDS）的自发性气胸（SP）于20世纪80年代出现。对于肺内科医生和外科医生而言，成功治疗这种疾病变得越来越困难。与艾滋病相关的SP伴有一种恶性的坏死性胸膜下坏死形式，会导致弥漫性漏气，而对于与典型胸膜下疱病相关的SP疗效良好的标准传统治疗方法对此却难以奏效。尽管进行了治疗，但与艾滋病相关的SP仍具有较高的死亡率，与原发性呼吸衰竭的发生无关。回顾我们在过去10年中对来自单一机构的46例患者的治疗经验，我们发现，由于原发性和继发性治疗失败率较高，建议采取积极的分步护理管理措施，即采用大口径肋间导管引流、化学性胸膜固定术和早期电视辅助滑石粉喷洒，以缩短住院时间、降低住院费用并降低死亡率。
