高浓度吸氧及胸穿抽气治疗大学生特发性稳定型小量气胸
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摘要
目的探讨不同高浓度间断吸氧方法结合胸穿抽气治疗特发性稳定型小量气胸的疗效。方法 129例大学生特发性稳定型小量气胸患者按先后时间段分为三组,每组给予不同高浓度氧流量间断吸氧,并对肺压缩>30%者入院后立即予胸穿抽气治疗,胸片证实肺压缩<30%后,按相对应时间段分别进入上述三组,比较其疗效。A组:40例,吸氧流量5~6L/min,每次2小时,每天3次;B组:44例,吸氧流量7~8L/min,每次1小时,每天2次;C组:45例,吸氧流量8~10L/min,每次30分钟,每天2次。结果三组高浓度间断吸氧方法联合胸穿抽气治疗前后肺压缩程度的比较有明显差异(P<0.001);B、C两组在肺压缩程度、肺复张天数和住院天数上与A组比较差异有统计学意义(P<0.01),但B、C两组之间差异无统计学意义(P>0.05);三组患者治疗前后的脉搏(P次/分)、血氧饱和度(SaO2%)比较,差异有统计学意义(P<0.01),但患者的呼吸频率(R次/分)无统计学差异(P>0.05);三组患者治疗前后的焦虑自评量表比较(根据SAS分值),差异有统计学意义(P<0.01)。结论对特发性稳定型小量气胸,面罩间断吸入7~10L/min的氧流量配合胸穿抽气治疗可达到比较满意的疗效并缩短住院时间。对特发性稳定型小量气胸患者,予以心电监护,有利监测病情,指导治疗;入院后应及时对患者进行病情宣教、心理疏导,可减少患者焦虑情绪,使其配合治疗,加快气胸的愈合。
Objective To explore the effect of different high concentration oxygen intermittent inhalation combined with chest pumping in the treatment of idopathic stable and slight pneumothorax.Methods 129 idopathic stable and slight pneumothorax patients were divided into Group A,Group B and Group C.Group A(40cases)was treated with oxygen flow rate 5~6L/min,2hours each time,three times a day.Group B(44cases)was treated with oxygen flow rate 7~8L/min,1hour each time,twice a day.Group C(45cases)was treated with oxygen flow rate of 8 ~10L/min,30 minutes each time,twice a day.The patients with pulmonary compression more than 30% got immediate chest pumping treatment when hospitalized.Patients with lung compression confirmed less than<30% by chest X-rays.The curative effect was observed.Results There was significant difference(P<0.001)in lung compression before and after the oxygen therapy in the three groups of high-concentration oxygen inhalation combined with chest pumping treatment(P<0.01).The three high oxygen concentration groups can speed up the absorption of pneumothorax and had significant effect in closed pneumothorax.There was significant difference among group A,group B and C in aspects of the lung compression degree,lung resuscitation time and hospitalization time(P<0.01),while no significant difference between group B and group C(P>0.05).There were significant statistic differences of pulse and blood oxygen saturation(P<0.01)among the three groups.Self-rating anxiety scales displayed significant difference among the three groups(P<0.01).Conclusion If the patients cant tolerate pure oxygen inhalation,the masked intermittent inhalation of 7~10L/min oxygen flow combined with chest pumping treatment can achieve a satisfactory effect and shorten hospital stay.In the treatment of idiopathic,stable and slight pneumothorax,intermittent masked inhalation 7~ 8L/min of oxygen flow can also achieve the same clinical effect.If possible,Idiopathic small pneumothorax patients with stable conditions can be treated with ECG monitoring,and get the disease education and mental nursing after hospital admission,reduce the anxiety of patients and help them accelerate the healing of pneumothorax.
Objective To explore the effect of different high concentration oxygen intermittent inhalation combined with chest pumping in the treatment of idopathic stable and slight pneumothorax.Methods 129 idopathic stable and slight pneumothorax patients were divided into Group A,Group B and Group C.Group A(40cases)was treated with oxygen flow rate 5~6L/min,2hours each time,three times a day.Group B(44cases)was treated with oxygen flow rate 7~8L/min,1hour each time,twice a day.Group C(45cases)was treated with oxygen flow rate of 8 ~10L/min,30 minutes each time,twice a day.The patients with pulmonary compression more than 30% got immediate chest pumping treatment when hospitalized.Patients with lung compression confirmed less than<30% by chest X-rays.The curative effect was observed.Results There was significant difference(P<0.001)in lung compression before and after the oxygen therapy in the three groups of high-concentration oxygen inhalation combined with chest pumping treatment(P<0.01).The three high oxygen concentration groups can speed up the absorption of pneumothorax and had significant effect in closed pneumothorax.There was significant difference among group A,group B and C in aspects of the lung compression degree,lung resuscitation time and hospitalization time(P<0.01),while no significant difference between group B and group C(P>0.05).There were significant statistic differences of pulse and blood oxygen saturation(P<0.01)among the three groups.Self-rating anxiety scales displayed significant difference among the three groups(P<0.01).Conclusion If the patients cant tolerate pure oxygen inhalation,the masked intermittent inhalation of 7~10L/min oxygen flow combined with chest pumping treatment can achieve a satisfactory effect and shorten hospital stay.In the treatment of idiopathic,stable and slight pneumothorax,intermittent masked inhalation 7~ 8L/min of oxygen flow can also achieve the same clinical effect.If possible,Idiopathic small pneumothorax patients with stable conditions can be treated with ECG monitoring,and get the disease education and mental nursing after hospital admission,reduce the anxiety of patients and help them accelerate the healing of pneumothorax.
引文
[1]陈灏珠.实用内科学[M].第13版.北京:人民卫生出版社,2009:1653-1671.
[2]姜波,曲福英.自发性气胸治疗方法选择探讨[J].中国现代医学,1999,9(9):35.
[3]刘江,孙朝阳.轻型气胸患者氧疗相关性分析[J].现代医药卫生,2009,25(10):1477-1478.
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[5]KellyA,LoyJ,TsangA,et al.Estimatingtherateofre-expansionof spontaneous pneumothorax by a formula derived from computed tomography volumetry studies[J].Emergency Medicine Journal,2006,23(10):780-782.
[6]JuanJ,MarceloF,LaureanoM,et al.Guidelines for the Diagnosis and Treatment of spontaneous pneumothorax[J].Arch Bronconeumol,2008,44(8):437-448.
[7]BaumannM,StrangeC,HeffnerJ,et al.Management of Spontaneous Pneumothorax An American College of Chest Physicians Delphi Consensus Statement[J].Chest,2001,119:590-602.
[8]陈灏珠.内科学[M].第8版.北京:人民卫生出版社,2016.123.
[9]Wakai A.Spontaneous pneumothrox[J].Clin Evid,2006,6(15):2032—2038.
[10]SahnSA,Heffner JE.Spontaneous pneumothorax[J].N Engl JMed,2000,342(12):868-874.
[11]Morimoto T,Fukui T,Koyama H,et al.Optimal strategy f or thefirstepisode of primary spontaneous pneumothorax in young men.A decision analysis[J].J Gen Intern Med,2002,17(3):193-202.
[12]姜波,李志壮.自发性气胸治疗方法选择的前瞻性研究[J].中国基层医药,2005,12(10):1413
[13]孟祥云.自发性气胸的护理[J].中国实用医学,2008,5(3):182.
[14]陈灏珠.内科学[M].第8版.北京:人民卫生出版社,2016.125.
[15]白明主译.现代肺部疾病诊断与治疗[M].北京:人民卫生出版社,2006:189.
[16]董敬军,陈建荣,陈金亮,等.不同吸氧方法治疗自发性气胸效果比较[J].实用医院临床杂志,2010,7(5):74-76.
[17]陈晶莹,王婉芳.氧疗对自发性气胸的临床意义和护理[J].安徽医药,2008,12(2):190.
[18]HenryM,ArnoldT,HarveyJ,et al.BTS guidelines for the management of spontaneous Pneumothorax[J].Thorax,2003,58(SupplII):ii39-ii52.
[19]DharmeshkumarN,AshishG,AgarwalS,et al.Oxygentoxicity[J].JIACM,2003,4(3):234-237.
[20]陈文彬.诊断学[M].第8版.北京:人民卫生出版社,2016:443.
[2]姜波,曲福英.自发性气胸治疗方法选择探讨[J].中国现代医学,1999,9(9):35.
[3]刘江,孙朝阳.轻型气胸患者氧疗相关性分析[J].现代医药卫生,2009,25(10):1477-1478.
[4]陈灏珠.内科学[M].第8版.北京:人民卫生出版社,2016:122.
[5]KellyA,LoyJ,TsangA,et al.Estimatingtherateofre-expansionof spontaneous pneumothorax by a formula derived from computed tomography volumetry studies[J].Emergency Medicine Journal,2006,23(10):780-782.
[6]JuanJ,MarceloF,LaureanoM,et al.Guidelines for the Diagnosis and Treatment of spontaneous pneumothorax[J].Arch Bronconeumol,2008,44(8):437-448.
[7]BaumannM,StrangeC,HeffnerJ,et al.Management of Spontaneous Pneumothorax An American College of Chest Physicians Delphi Consensus Statement[J].Chest,2001,119:590-602.
[8]陈灏珠.内科学[M].第8版.北京:人民卫生出版社,2016.123.
[9]Wakai A.Spontaneous pneumothrox[J].Clin Evid,2006,6(15):2032—2038.
[10]SahnSA,Heffner JE.Spontaneous pneumothorax[J].N Engl JMed,2000,342(12):868-874.
[11]Morimoto T,Fukui T,Koyama H,et al.Optimal strategy f or thefirstepisode of primary spontaneous pneumothorax in young men.A decision analysis[J].J Gen Intern Med,2002,17(3):193-202.
[12]姜波,李志壮.自发性气胸治疗方法选择的前瞻性研究[J].中国基层医药,2005,12(10):1413
[13]孟祥云.自发性气胸的护理[J].中国实用医学,2008,5(3):182.
[14]陈灏珠.内科学[M].第8版.北京:人民卫生出版社,2016.125.
[15]白明主译.现代肺部疾病诊断与治疗[M].北京:人民卫生出版社,2006:189.
[16]董敬军,陈建荣,陈金亮,等.不同吸氧方法治疗自发性气胸效果比较[J].实用医院临床杂志,2010,7(5):74-76.
[17]陈晶莹,王婉芳.氧疗对自发性气胸的临床意义和护理[J].安徽医药,2008,12(2):190.
[18]HenryM,ArnoldT,HarveyJ,et al.BTS guidelines for the management of spontaneous Pneumothorax[J].Thorax,2003,58(SupplII):ii39-ii52.
[19]DharmeshkumarN,AshishG,AgarwalS,et al.Oxygentoxicity[J].JIACM,2003,4(3):234-237.
[20]陈文彬.诊断学[M].第8版.北京:人民卫生出版社,2016:443.