荟萃11-第二篇第七章自发性气胸课件.ppt

1、1气胸2任何原因使胸膜破损，空气进入胸膜任何原因使胸膜破损，空气进入胸膜腔，称为气胸。腔，称为气胸。可分为三类：可分为三类：一、人工气胸一、人工气胸二、创伤性气胸二、创伤性气胸三、自发性气胸三、自发性气胸（一）原发性气胸（又（一）原发性气胸（又称特发性气胸称特发性气胸）（二）继发性气胸（二）继发性气胸肺气肿、肺结核等肺气肿、肺结核等Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 3自发性气胸自发性气胸?一、病因和发病机制：?特发

2、性气胸?自发性气胸常继发于基础肺部病变。?自发性气胸以继发于慢性阻塞性肺病和肺结核最为常见，其次是特发性气胸。?举重物等用力动作，咳嗽、喷嚏、屏气或高喊大笑等常为气胸的诱因。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 4二、临床类型；?自发性气胸分为以下三种类型：自发性气胸分为以下三种类型：?1、闭合性(单纯性)气胸：?2 2、张力性(高压性)气胸：?3 3、交通性、交通性(开放性)气胸：Our greatest weakn

3、ess lies in giving up.The most certain way to succeed is always to try just one more time 5三、临床表现：三、临床表现：患者常有持重物、剧烈运动、用力排便、咳嗽患者常有持重物、剧烈运动、用力排便、咳嗽等屏气用力动作的诱因。等屏气用力动作的诱因。1 1、症状：、症状：?（1 1）、胸痛：首先发生的是，突然出现程度不同的发生的是，突然出现程度不同的胸痛，呈呈刀割样或针刺样。刀割样或针刺样。（2 2）、呼吸困难：呼吸困难 与胸痛同时发生。（3 3）、咳嗽：多为干咳。（4 4）、心肺功能不全：多发生于张力性气胸多

4、发生于张力性气胸严重气急，烦躁不安、发绀、出汗、脉搏严重气急，烦躁不安、发绀、出汗、脉搏细速，可有休克，甚至昏迷。细速，可有休克，甚至昏迷。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 62、体征：少量气胸仅呼吸音减低，胸腔积气多时：望：患侧胸廓饱满，肋间隙增宽，呼吸运动减弱，心尖搏动向健侧偏移。触：患侧语颤减弱，气管向健侧偏移。叩：患侧叩诊呈鼓音。听：患侧呼吸音减低或消失。右侧气胸时肝浊音界下降，左侧气胸时心浊音界叩不清。O

5、ur greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 73、X线检查是诊断气胸的重要方法，并可明确肺脏被压缩的程度（%）。（1）、气胸部位透亮度增加，无肺纹理。（2）、肺组织萎陷被压向肺门，呈高密度阴影。（3）、脏层胸膜呈纤细的发线影（气胸压缩线）。（4）、纵隔、气管向健侧偏移。如有积液可见液平面Our greatest weakness lies in giving up.The most certain way to succeed

6、 is always to try just one more time 8气胸气胸Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 9四、辅助检查：?X线检查是诊断气胸的重要方法，可以显示肺脏萎缩的程度，肺内病变情况以及有无胸膜粘连、胸腔积液和纵隔移位等。气胸线以外透亮度增高，无肺纹可见。有时气胸线不够显现，可嘱病人呼气，肺脏体积缩小，密度增高，与外带积气透光带形成对比，有利于发现气胸。Our greatest weakness

7、 lies in giving up.The most certain way to succeed is always to try just one more time 10气胸胸片气胸胸片?Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 11气胸X X线Our greatest weakness lies in giving up.The most certain way to succeed is always to t

8、ry just one more time 12液气胸液气胸Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 13右侧液气胸X X线片Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 14五、诊断和鉴别诊断：?突发一侧胸痛，伴有呼吸困难井有气胸体征，即可作出初步诊断。

9、x线显示气胸征是确诊依据。?自发性气胸有时酷似其他心、肺疾患，应予鉴别。?1、支气管哮喘和阻塞性肺气肿：?2、急性心肌梗塞：?3、肺栓塞：?4、肺大疱：Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 15六、治疗：?治疗原则在于根据气胸的不同类型适当进行排气，以解除胸腔积气对呼吸、循环所造成的障碍，使肺尽早复张，恢复功能，同时也要治疗并发症和原发病。（一）、保守治疗肺脏萎缩25%，可每日或隔日抽气 1次，每次抽气不宜超过1000

10、ml，直至肺大部复张。2、张力性气胸：应进行紧急排气。十分危急时，可将消毒针头插入患侧锁骨中线第2肋间，使高压气体排出，以缓解症状。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 17为确保有效持续排气，通常应用胸腔闭式水封瓶引流。插管部位常规取：患侧锁骨中线第2肋间或腋前线第45肋间。胸腔闭式水封瓶引流方式：两种（1）、水封瓶正压排气法：可使胸膜腔内压力保持在 12cmH2O以下。Our greatest weakness l

11、ies in giving up.The most certain way to succeed is always to try just one more time 18水封瓶正压排气法装置Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 19（2）、持续负压排气法使胸膜腔内负压不低于-8-12cmH2O。水封瓶应放在低于患者胸部的部位。使用闭式负压吸引宜连续开动吸引器，如经12小时后肺仍未复张，应查找原因。如无气泡冒出，12

12、天，并经 X线检查肺已全部复张，可夹管，观察2448小时，证实肺脏仍复张良好，即可拔除引流管，用凡士林纱布覆盖手术切口。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 20Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 213 3、交通性气胸原则上应作肋间插管水封

13、瓶引流，必要时加负压吸引。如证实胸膜因有粘连带牵拉破口不能闭合时，需手术行胸膜粘连带烙断术。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 22（三）、原发病治疗和对症治疗：抗感染、镇咳、祛痰、镇痛，保持大便通畅等。（四）、胸膜粘连术：经上述处理无效或多次复发者，可胸腔内注入化学粘连剂，使产生无菌性变态反应性胸膜炎症，使两层胸膜粘连，防止气胸复发。常用的化学粘连剂有：四环素粉针剂、无菌精制滑石粉、50%50%葡萄糖、自身血液等。

14、（五）、经胸腔镜治疗气胸：（六）、手术疗法：经上述处理仍不吸收，如禁忌证，可行破裂口缝合、胸膜纤维被膜剥离术等。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 23七、七、预后预后大多可治愈，5%30%患者易复发。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 24八、八、预防预防积极治疗原发病，避免持重物、剧烈运动、用力排便、咳嗽等诱因。必要时行胸膜粘连术。