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尘肺并发双侧自发性气胸21例临床分析

目的　探讨尘肺并发双侧自发性气胸的诱发因素、临床特点和急救处理方法，以减少误诊和降低死亡率。方法　回顾性分析2006年3月至2012年1月重庆市职业病防治院21例尘肺并发双侧自发性气胸患者的临床资料，男20例，女1例；平均年龄62 （46～65） 岁。发病缓慢者4例，突发起病17例。术前肺压缩程度＜30% 6例，30%～50% 10例，＞50% 5例。二期尘肺7例，三期14例。所有患者均采用双侧胸腔闭式引流术治疗。 结果　气胸治愈13例，好转5例；1例因持续漏气转外院行电视胸腔镜手术治疗好转出院；2例因早期患者不愿意采用手术治疗，而采用内科保守治疗延误手术时机，致急性呼吸循环衰竭死亡。胸腔引流管平均引流时间10.4 （4～24） d。随访17例，随访时间5～12个月，16例气胸无复发，1例并发右侧少量气胸经保守治疗痊愈，2例失访。 结论　尘肺并发双侧气胸患者多数突然发病，临床症状有时不典型，易误诊，发生严重的缺氧和急性呼吸功能衰竭，从而危及患者生命；对明确诊断者及时行双侧胸腔闭式引流术治疗是救治成功的关键。

胸腔引流管拔除后急性大面积皮下气肿二例

Clinical analysis of single mediastinal chest drains in perioperative period after thoracoscopic resection of esophageal carcinoma: A randomized controlled study

ObjectiveTo compare the clinical effect of single mediastinal drainage tube and both mediastinal drainage tube and closed thoracic drainage tube for the patients who received thoracoscopic radical resection of esophageal carcinoma.MethodsWe enrolled 96 esophageal carcinoma patients who received thoracoscopic radical resection from June 2016 to October 2018. Of them, 49 patients were indwelt with both mediastinal drainage tube and closed thoracic drainage tube (a chest & mediastinal drainage group, a CMD group) while the other 47 patients were indwelt with single mediastinal drainage tube (a single mediastinal drainage group, a SMD group). The total drainage volume, intubation time and incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) between the two groups were compared. The pain score and comfort score were also compared between the two groups.ResultsThe total drainage volume and intubation time in the SMD group were not significantly different from those in the CMD group (1 321±421 mL vs. 1 204±545 mL, P=0.541; 6.1±3.7 d vs. 6.4 ±5.1 d, P=0.321). The incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) in the SMD group was not significantly different from that in the CMD group (10.6% vs. 6.1%, P=0.712; 4.3% vs. 10.2%, P=0.656; 6.4% vs. 12.2%, P=0.121; 2.1% vs. 4.1%, P=0.526). The numerical rating scale (NRS) pain scores on the first to the fifth day after surgery and during extubation in the SMD group were significantly lower than those in the CMD group (3.2±2.1 vs. 5.1±2.4, P=0.041; 2.8±0.6 vs. 4.8±1.4, P=0.015; 2.1±0.4 vs. 4.5±0.4, P=0.019; 1.7±0.7 vs. 4.0±0.8, P=0.004; 1.8±0.7 vs. 3.2±1.2, P=0.006; 1.4±0.2 vs. 2.5±3.4, P=0.012). The VAS comfort scores in the SMD group were significantly lower than those in the CMD group (3.6±1.7 vs. 6.6±3.7, P=0.018; 2.9±2.0 vs. 5.1±3.4, P=0.007; 2.1±1.4 vs. 5.5±2.4, P=0.004; 3.0±0.9 vs. 4.6±3.8, P=0.012; 1.8±1.1 vs. 4.2±2.7, P=0.003; 2.4±3.2 vs. 5.3±1.7, P=0.020).ConclusionThe clinical effect of single mediastinal drainage tube in thoracoscopic resection of esophageal carcinoma is similar to that of both mediastinal drainage tube and closed thoracic drainage tube, but it can significantly improve the comfort of the patients.