Definition: Spontaneous pneumothorax refers to some kind of lesion in the lung, spontaneous rupture of alveoli and dirty pleura, air enters the pleura leading to lung atrophy and different degrees of respiratory dysfunction.
Second, the etiology: pulmonary cyst pulmonary blister formation, pulmonary tuberculosis (chronic fibro-cavernous pulmonary tuberculosis), slow branch, emphysema, bronchial asthma, interstitial fibrosis, pulmonary sepsis, menstrual pneumothorax, positive pressure artificial ventilation, etc. Some cases are called idiopathic pneumothorax because the cause cannot be identified.
Symptoms and signs: The symptoms vary in severity. The common symptoms are sudden onset of chest pain, cough, dyspnea, or no symptoms at all in mild cases. The signs may include fullness of the affected side of the chest, widening of the rib space, weakened respiratory movement, enhanced percussion sounds or reverberant sounds, and reduced or absent breath sounds on auscultation.
IV. Examination.
1.Thorough X-ray fluoroscopy or radiography, it can be seen that the lung tissue is compressed, and there is a curved convex pneumothorax line at the junction of the pneumothorax and the compressed lung tissue, and the mediastinum is displaced to the opposite side.
2.CT of the chest can detect pneumothorax, hemopneumothorax and pulmonary maculopathy.
3.Thoracoscopy: It is used for etiological diagnosis and treatment.
V. Diagnosis: According to the typical symptoms, signs and chest X-ray and CT examination, the diagnosis is generally not difficult. Its clinical bed typing is as follows.
(a) closed (simple type): the lung surface rupture can be closed by itself, and the chest cavity maintains negative pressure after suction, and the residual gas can be absorbed by itself.
(B) open (traffic type): the rupture is larger, and the thoracic cavity is connected with the bronchus. The pressure in the thoracic cavity is equal to the atmospheric pressure.
(c) Tension (high-pressure type): there is a valve formed at the rupture, and the air enters the thoracic cavity during inspiration and closes the valve during expiration, and the pressure in the thoracic cavity increases continuously.
Differential diagnosis: Spontaneous pneumothorax needs to be differentiated from obstructive emphysema, emphysematous pneumomediastinum, wheezing bronchitis and bronchial asthma.
VII. Treatment.
(a) General treatment: bed rest should be given. Those with lung compression below 20% and no obvious respiratory distress can be absorbed naturally. High concentration oxygen therapy can accelerate the absorption of pneumothorax. Give coughing and expectorant drugs to those with severe cough. Sedatives should be given to those with excessive nervousness, laxatives should be given to those with constipation, and antibiotics should be given to those with infection.
(B) Exhaustion
1.Emergency venting: Once the high pressure pneumothorax is identified, a large syringe needle should be quickly inserted into the chest cavity to vent the air. In the absence of medical conditions, the chest wall can be punctured with any sharp instrument at hand. When the situation allows, a large needle can be used to tie the front end of a medical rubber glove or condom to the shank of the needle, and then cut a slit in its blind end, and then inserted into the chest cavity and fixed, that is, a one-way exhaust device, the method is simple and effective, and to buy time for further processing.
Puncture site selection is generally in the second intercostal area of the midclavicular line, but also in the highest air accumulation.
2, artificial exhaust method: according to the conventional puncture site for pleural puncture. The initial pumping volume should generally be <1000ml, once a day or every other day, until the lung reopens. If the pneumothorax is still not absorbed after two weeks, closed drainage by water-sealed bottle should be used instead. This method is applicable to all types of pneumothorax, and the pressure in the chest cavity can be measured at the same time.
3.Water seal bottle closed drainage: the position of the cannula incision is the same as before, if there is liquid pneumothorax, the height of the liquid-air interface should be taken, and the cannula used is better than the thicker silicone tube or anal tube. Cut 3-4 small holes at the front of the catheter and hold it with hemostatic forceps. Puncture the pleura to send into the chest cavity, the insertion depth of 2-3cm, too shallow catheter easy to dislodge, too deep will be the lung reopening when the top of the lung tissue patient pain, catheter and water seal bottle connected. The glass tube connected to the catheter into the water depth of 2-3cm is appropriate. Care should be taken to keep the drainage tube open and to change the fluid in the water seal bottle regularly. Pneumothorax patients should have regular culture of pleural fluid. After the lung rises to clip the tube 1-2 days, the recurrence can be dialed.
4, negative pressure attraction: if the above water seal bottle drainage still can not make the rupture healing see the lung persistently can not reopen, can choose another intubation, or in the original smooth end of the drainage tube with negative pressure attraction closed drainage device.
As the attraction machine into negative pressure is too large, the regulator bottle used to regulate the pressure tube in the water 6-12cm, so that the negative pressure is not higher than – 8 – 12cm If the negative pressure is higher than this limit, the room control by the pressure regulator tube into the regulator bottle, so the patient’s chest cavity withstand the negative pressure of attraction than – 8 – 12cm higher, so as to avoid negative pressure attraction to the lungs cause greater loss. Use closed negative pressure suction to continuously open the suction bottle, but if the lung has not reopened for more than 12 hours, the reason should be found. If the lung has completely reopened, it can be maintained at a lower negative level and continue to pump for 1-2 days, then clamp the drainage tube and stop the negative pressure suction. 2-3 days, if the pneumothorax does not recur, make the catheter checked and removed.
(C) Surgical treatment: When medical treatment is ineffective, surgical operation can be considered, and at present, the main consideration is thoracoscopic lesion excision, etc. The indications are as follows.
1, continuous negative pressure continuous exhaust for more than a week still can not be reopened, or large mouth.
2.Two or more ipsilateral episodes of spontaneous pneumothorax.
3.Those who can see huge pneumothorax and those who have obvious possibility of recurrence although it is the first attack.
4.Chronic pneumothorax for more than three months without reopening, or with bronchopleural disease, etc.
5.Complicated hemothorax, abscess chest medical treatment is ineffective.