I. Overview and definition of pneumothorax
Pneumothorax is a condition in which gas enters the pleural cavity for any reason, causing pneumatization. Pneumothorax is one of the common emergencies, and its incidence is about 5~46/100,000. If not diagnosed and treated in time, it may lead to respiratory and circulatory dysfunction or even death.
Classification of pneumothorax
1.Spontaneous pneumothorax (primary, secondary)
2.Traumatic pneumothorax
3.Medically induced pneumothorax
4.Special type of pneumothorax (pneumatic pressure injury, menstrual pneumothorax, recurrent pneumothorax of pregnancy)
Marfan’s syndrome combined with pneumothorax)
III. Etiology and pathogenesis
Pneumothorax occurs in three conditions
1.A rupture between the alveoli and the chest cavity, and gas enters the chest cavity from the alveoli until the pressure difference disappears or the rupture closes
2.Trauma to the chest wall generates traffic with the chest cavity
3.The presence of gas-producing microorganisms in the thoracic cavity
IV. Clinical types
1.Closed (simple)
2.Tensional (high pressure)
3.Transportation (open)
V. Clinical manifestations
1.Related to underlying disease, speed of occurrence, volume and pressure of air accumulation
2.Symptoms: dyspnea, chest pain, irritating dry cough
3.Signs: depends on the amount of air accumulation and whether it is accompanied by pleural effusion
Increased respiration, cyanosis (tension pneumothorax)
Trachea, heart shifted to the healthy side
Chest: Visual: fullness of the thorax, reduced respiratory mobility
Tactile — decreased fibrillation
Percussion—drum sounds
Hearing—reduction or disappearance of breath sounds
VI. Diagnosis and differential diagnosis
1.The most reliable method to diagnose pneumothorax – imaging examination (X-ray, CT)
2.Differential diagnosis.
(1) Bronchial asthma and obstructive pulmonary emphysema
(2) Acute myocardial infarction
3, pulmonary embolism
4, other: pleurisy, gastric perforation, lung cancer, etc.
Seven, the purpose of treatment
Promote lung reopening on the affected side, eliminate the cause and reduce recurrence
Eight, treatment measures
1.Conservative treatment
Mainly applicable to small amount of stable pneumothorax. The first occurrence of closed pneumothorax with mild symptoms.
Measures: Strict bed rest, analgesia, cough suppression, oxygenation and treatment of underlying lung diseases as appropriate. Pay attention to the need for close monitoring of changes in the condition.
2.Exhaustion treatment
Indications:
①Closed pneumothorax with lung compression >20%
②Tension pneumothorax
③Open pneumothorax
Method:
①Chest puncture and venting
②closed drainage of the chest cavity
3.Chemical pleural fixation
Suitable for patients who are not suitable for surgery or refuse surgery
4.Indications for surgical treatment.
(1) Recurrent pneumothorax;
(2) Chest X-ray or CT examination confirmed the presence of pulmonary blisters;
(3) Pneumothorax combined with thoracic hemorrhage;
(4) Effective closed drainage of the chest cavity for 72 hours still has a large amount of gas spillage;
(5) Patients engaged in special occupations, such as pilots, divers, high-altitude work, etc.
5.Thoracoscopic treatment.
(1) Minimally invasive thoracoscopic surgery, small incision, no need to remove or open the ribs, respiratory muscle is not broken, less intraoperative bleeding. (1) Thoracoscopic surgery is minimally invasive, with small incisions, no need to remove or open the ribs, no damage to the respiratory muscles, and little intraoperative bleeding.
(2) The operation has little effect on the movement of upper limbs, which improves the quality of life of patients after surgery, especially for patients with thoracic trauma who are old and frail, have poor cardiopulmonary function and cannot tolerate conventional open-heart surgery.
6.Open-chest surgery.
Axillary incision – has the characteristics of concealed wound, small trauma, fast recovery and economy.