內(nèi)科學(xué)課件：氣胸英文

1、Pneumothorax Definition Pneumothorax is defined as air in the pleural cavity. Classification Etiological classificationSpontaneous pneumothorax: ( primary and secondary ) Traumatic pneumothorax: Iatrogenic pneumothoraxAccording to the pressure in pleural spaceClosed pneumothoraxOpened pneumothoraxTe

2、nsion pneumothorax: Primary spontaneous pneumothorax : Primary spontaneous pneumothorax occurs when there is no known underlying lung disease. It is thought to be caused by the rupture of a small, air-filled sac in the lung called a bleb or a bulla. Primary spontaneous pneumothoraces result from api

3、cal pleural blebs lying under the visceral pleura. Primary spontaneous pneumothorax affects tall, thin men between 20 and 40 years old most frequently. Cigarette smoking and family history are contributing factors. Secondary spontaneous pneumothorax : Secondary spontaneous pneumothorax is a complica

4、tion of underlying pulmonary diseases (COPD, asthma, cystic fibrosis, tuberculosis, pneumocystis pneumonia ). Traumatic pneumothorax results from a traumatic injury to the chest. The trauma may be penetrating (stab wound, gunshot) or blunt (blow from a motor vehicle accident). Iatrogenic pneumothora

5、x may follow procedures such as thoracentesis, pleural biopsy, subclavian or internal jugular vein catheter placement, percutaneous lung biopsy and positive-pressure mechanical ventilation. Tension pneumothorax is a medical emergency. It is caused when excessive pressure builds up around the lung, f

6、orcing it to collapse. The excessive pressure can also prevent the heart from pumping blood effectively, leading to shock.Symptoms and signsSymptoms:sudden sharp chest pain, especially made worse by a deep breath or a cough shortness of breath chest tightness easy fatigue rapid heart rate cyanosis o

7、f the skin caused by lack of oxygenNote:Symptoms may begin during rest or sleep. Pneumothorax may present with life-threatening respiratory failure if underlying COPD or asthma is present; this is true irrespective of the size of the pneumothorax. Signs:If pneumothorax is small (less than 15% of a h

8、emithorax ), physical findings, are unimpressive. If pneumothorax is large, we can find some signs. Inspection: unilateral chest expansion Palpation: decreased tactile fremitus Percussion: tympany Auscultation: diminished breath soundsAuxiliary ExaminationChest X-ray : Chest X-ray determine presence

9、 of air outside the lung . Demonstration of a visceral pleural line on chest radiograph is diagnostic . Arterial blood gas: Arterial blood gas analysis reveals hypoxemia and acute respiratory alkalosis in most patients but is often unnecessary. CT scanCT scan is not recommended for routine use but c

10、an help to accomplish the following:Distinguish between a large bulla and a pneumothoraxIndicate underlying emphysema or emphysemalike changesDetermine the exact size of the pneumothorax, especially if it is smallChest radiograph (confirms pneumothorax)A linear shadow of visceral pleura with lack of

11、 lung markings may be observed, indicating collapsed lung.Visceral pleural line is observed clearly, with the absence of lung marking beyond this line. Large spontaneous tension pneumothorax. Right-sided pneumothoraxDiagnosis(1) Acute onset of ipsilateral chest pain and dyspnea.(2) Minimal physical

12、findings in mild case; If pneumothorax is large, you can finding characteristic signs of penumothorax; cyanosis in tension pneumothorax.(3) Presence of visceral pleural line on chest radiograph. Treatment The objective of treatment is to remove the air from the pleural space, allowing the lung to re

13、-expand. All patients with pneumothorax must stop smoking in order to reduce the risk of recurrent pneumothorax. Administer oxygen to all patients. Most patients are admitted to the hospital. Treatment for pneumothorax includes observation, simple aspiration, closed drainage of pleural cavity( chest

14、 tube placement or tube thoracostomy), chest drain suction, chemical pleurodesis and thoracic surgery.traumatic pneumothorax usually requires chest tube placement. Iatrogenic pneumothorax is frequently treated with observation or simple aspiration. Tension pneumothorax is a medical emergency that re

15、quires immediate needle decompression and chest tube placement. Small pneumothoraces may resolve on their own. In a reliable patient with a small (15% of a hemithorax ), closed spontaneous pneumothorax without significant breathlessness, observation alone may be appropriate. ThoracentesisSimple aspi

16、ration (thoracentesis) is performed by placing a plastic catheter over the needle into the pleural space. Simple aspiration can be helpful for closed pneumothoraxThe puncture site is commonly in the second or third intercostal space in the midclavicular line or in the fourth or fifth intercostal spa

17、ce over the superior rib margin in the anterior axillary line. Closed drainage of pleural cavityThe placement of a chest tube between the ribs into the pleural space allows the evacuation of air from the pleural space. Patients with opened and tension pneumothorax should undergo tube thoracostomy.Th

18、e chest tube is inserted through an incision between the ribs into the chest and is connected to a bottle that contains sterile water. The chest tube usually remains in place until the X-rays show that all air has drained from the chest and the lung has fully re-expanded. Incision siteAnesthetizing

19、TissuesIncision and DissectionPlacing the Tube and connecting Pleural Drainage SystemsSecuring the TubeTension pneumothorax is an emergency. Treat this emergency by inserting a large-bore needle into the pleural space through the second or third anterior intercostal space. A gush of air confirms the diagnosis. Leave the needle in place until the chest tube is placed. Chest drain suction: low pressure(-10 to -20cmH2O suction system Chemical pleurodesis: the instillation of substances(salc or