Soulsby T
Accident and Emergency Department, Fazakerley Hospital, Liverpool.
J Accid Emerg Med. 1998 Sep;15(5):317-21. doi: 10.1136/emj.15.5.317.
To determine how British Thoracic Society (BTS) guidelines for the management of spontaneous pneumothorax have been implemented over a four year period in a large district general hospital with a specialised respiratory unit. To assess the validity of the guidelines in the management of spontaneous pneumothorax.
A retrospective case notes study over a four year period for all patients with spontaneous pneumothoraces attending the accident and emergency (A&E) department of a large district general hospital.
115 episodes of spontaneous pneumothorax were identified. Overall 20.8% of episodes were treated correctly by BTS guidelines. Decisions made by A&E staff were significantly more likely to be correct than decisions made by on call medical teams (39.4% v 13.4%, p = 0.002). There was a non-significant trend towards better compliance with BTS guidelines over the four year period. The management decision was made by A&E staff only in 28.7% of episodes. Patients without chronic lung disease could be safely observed as outpatients. Forty three pneumothoraces were aspirated: 23 (58%) successfully; eight (18.6%) with little or no improvement; and 12 (27.9%) initially successfully but developing increased size of pneumothorax within a period of 72 hours. Three patients had repeat aspirations, two successfully. Age over 50, chronic lung disease, and more than 2.5 litres of air aspirated were significantly associated with failure of aspiration (p < 0.01). There was a 28.6% failure rate of aspiration for patients with moderate pneumothoraces without chronic lung disease.
Patients over the age of 50 should be treated the same as patients with chronic lung disease. A second aspiration should be attempted if the first aspiration is initially successful with subsequent recurrence of pneumothorax. Further research is required to clarify if patients with moderate pneumothoraces under the age of 50 and no chronic lung disease should be aspirated or observed.
确定英国胸科学会（BTS）自发性气胸管理指南在一家设有专业呼吸科的大型区综合医院四年期间的实施情况。评估该指南在自发性气胸管理中的有效性。
对一家大型区综合医院急诊科四年期间所有自发性气胸患者进行回顾性病例记录研究。
共识别出115例自发性气胸发作。总体而言，20.8%的发作按照BTS指南得到了正确治疗。急诊科工作人员做出的决策比值班医疗团队做出的决策更有可能正确（39.4%对13.4%，p = 0.002）。在这四年期间，对BTS指南的依从性有不显著的改善趋势。仅在28.7%的发作中由急诊科工作人员做出管理决策。无慢性肺病的患者可作为门诊患者安全观察。43例气胸进行了抽气：23例（58%）成功；8例（18.6%）改善很少或没有改善；12例（27.9%）最初成功，但在72小时内气胸增大。3例患者进行了重复抽气，2例成功。年龄超过50岁、慢性肺病以及抽气超过2.5升与抽气失败显著相关（p < 0.01）。无慢性肺病的中度气胸患者抽气失败率为28.6%。
50岁以上患者应与慢性肺病患者接受相同治疗。如果首次抽气最初成功但随后气胸复发，应尝试进行第二次抽气。需要进一步研究以明确50岁以下无慢性肺病的中度气胸患者应进行抽气还是观察。
