It is a pathophysiological condition caused by the rupture of the dirty pleura without trauma or human factors, and the gas enters the pleural cavity resulting in pneumothorax, which is called idiopathic pneumothorax if there is no obvious lung lesion formed by the rupture of subpleural emphysematous vesicles; it is called secondary pneumothorax if it is secondary to pleural and lung diseases such as chronic obstructive pulmonary tuberculosis, and it is divided into closed (simple), open (traffic) and tension (high pressure) according to the pathophysiological changes. Three categories.
Diagnosis
I. Medical history and symptoms.
May or may not have force to increase the chest, skin cavity pressure and other triggers, more sudden onset, the main symptoms are dyspnea, affected chest pain, irritating dry cough, tension pneumothorax symptoms severe irritability, may appear cyanosis, sweating or even shock.
Second, physical examination reveals that.
A small amount or limited pneumothorax mostly has no positive signs. In typical cases, the trachea is displaced to the healthy side, the affected side of the thorax is full, the respiratory motion is reduced, the buckle is over clear, and the respiratory sound is reduced or disappeared. In the case of left-sided pneumothorax complicated with mediastinal emphysema, sometimes the pyrophonic sound consistent with heartbeat can be heard in the precordial region (Hamman’s sign).
Third, auxiliary examinations.
(A) X-ray chest examination: It is the most reliable diagnostic method to determine the degree of pneumothorax, the compression of the lung, the presence of mediastinal emphysema, pleural effusion and other complications.
(B) Other examinations: (1) blood gas analysis, hypoxemia may occur in those with lung compression >20%. (2)Thoracentesis manometry, which helps to determine the type of pneumothorax. (3)Thoracoscopy: for chronic and recurrent pneumothorax, it helps to figure out the lung surface and pleural lesions. (4)Hematological examination: no positive finding when there is no complication.
IV. Differential diagnosis.
It should be differentiated from acute myocardial infarction, subpleural pulmonary alveoli, bronchial cysts, septal hernia, etc.
Treatment measures
I. Symptomatic treatment.
Bed rest should be given, oxygen, analgesia, cough, antibiotic treatment if there is infection.
Second, thoracic decompression.
(1) closed pneumothorax, lung compression <20%, simple bed rest leisure pneumothorax can be self-absorption, lung compression >20% symptoms should be thoracentesis pumping 1/1 ~ 2d times, each time 600 ~ 800ml is appropriate.
(2) open pneumothorax, the application of closed chest drainage exhaust, the lung still can not be reopened, can be added with negative pressure continuous suction.
(3) Tension pneumothorax, the condition is more critical must be exhausted and decompressed as soon as possible, while preparing to immediately perform closed chest drainage or negative pressure continuous suction.
Third, surgical treatment.
For those who cannot reopen the lung even after active medical treatment, chronic pneumothorax or bronchopleural fistula can be considered for surgery, and recurrent pneumothorax can be treated by pleural adhesions.
Fourth, active treatment of primary diseases and complications.