Selby C D, Sudlow M F
Department of Medicine, University of Edinburgh, Royal Infirmary.
Scott Med J. 1994 Jun;39(3):75-7. doi: 10.1177/003693309403900306.
In a retrospective, case-note based, audit of the initial management of spontaneous pneumothoraces in a large teaching hospital, 38 events were identified in 37 patients admitted over 12 months to the end of September 1991. The initial management was intercostal tube drainage in 21 (55%), decided upon by middle grade staff, with a cost in terms of the duration of hospitalisation (median 7 (range 2-18) days), chest radiography (6 (3-10) films) and potential for complications including infections (3 wound, 2 chest). Aspiration was performed in only three cases, the remainder were managed by observation. We suggest that undue reliance is placed upon intercostal tube drainage to treat spontaneous pneumothoraces with aspiration alone performed too infrequently. Moreover, other deficiencies in management including the practise of drain clamping and incomplete follow-up were identified.
在一家大型教学医院对自发性气胸初始治疗进行的一项基于病例记录的回顾性审计中，在截至1991年9月底的12个月内收治的37例患者中发现了38起此类事件。21例（55%）的初始治疗采用肋间引流管引流，由中级医务人员决定，在住院时间（中位数7天（范围2 - 18天））、胸部X光检查（6次（3 - 10次））以及包括感染（3例伤口感染、2例胸部感染）在内的并发症发生可能性方面都有相应成本。仅3例进行了穿刺抽吸，其余患者采用观察治疗。我们认为，在治疗自发性气胸时过度依赖肋间引流管引流，而穿刺抽吸单独使用的频率过低。此外，还发现了管理方面的其他不足之处，包括引流管夹闭操作以及随访不完整等问题。
