摘要
目的 探讨胸腔气体和呼出气体的氧分压及二氧化碳分压的测定对自发性气胸患者脏层胸膜破口闭合的预测价值。方法 对于确诊为原发性自发性气胸的患者，利用自行研制的呼出气采集器采集患者的呼气末气体，通过胸腔穿刺收集胸腔气体，分别测定两种气体的氧分压和二氧化碳分压，利用胸部X线观察肺复张情况，并以此作为判定脏层胸膜破口是否闭合的金标准，研究呼出气体和胸腔气体的氧分压、二氧化碳分压之间的关系及变化规律。结果 （1）p呼O2 、p呼 CO2、pp CO2 / ppO2与脏层胸膜的闭合情况呈负相关，即p呼O2 、p呼 CO2、pp CO2 / ppO2的值越大，越可能是闭合性气胸；pp CO2 、ppO2与脏层胸膜的闭合情况呈正相关，即pp CO2、ppO2的值越小，越可能是闭合性气胸。结论 利用胸腔气体和呼出气体进行氧分压和二氧化碳分压测定对自发性气胸患者脏层胸膜破口是否闭合是具有预测价值的。
关键词： 气胸；临床类型；气体分压；闭合
Abstract
Objective To study the predictive value of evaluation in gas partial pressure of pleural cavity and expiration to the closure of visceral pleura in spontaneous pneumothroax patients. Methods: To collect the expiratory gas by the device which we designed and produced. To detect the oxygen partial pressure and carbon dioxide partial pressure respectively, and the blood gas analysis of radial artery was done at same time. The data was analyzed and sorted to find the relationship between them. Combine the data with the radiographic information to predict whether the leakage of the visceral pleura is closed. Results: The higher the value of p呼O2 、p呼 CO2、pp CO2 / ppO2 , the more possibility of closed pneumothroax. pp CO2 、ppO2 is positively correlated with the closure of visceral pleura, the higher the value of pp CO2 、ppO2 ,the more possibility of traffic pneumothroax. Conclusion : To utilize the evaluation of gas partial pressure can predict whether the leakage of the visceral pleura is closed.
Key words： pneumothroax; clinical type; gas partial pressure; closure
参考文献 References
[1] 钱桂生,杨晓静，赵自强等.胸腔气体分析在自发性气胸诊断中的价值[J].中国危重病急救医学,1994,6(1):21-23.
[2] 方建新，周桂英，林沙菊英.胸腔气体分析在鉴别自发性气胸类型中的价值. 华西医学,1997, 12(3):328.
[3] 朱文玉.医学生理学[M].北京：北京大学医学出版社，2009:122-123.
[4] Y.TAKANO，O.SAKAMOTO，C.KIYOFUJI et al. A comparison of the end-tidal CO2 measured by portable capnometer and the arterial PCO2 in spontaneously breathing patients. Respiratory Medicine.2003, Vol 97:476-481.
[5] 刘杰，陈荣昌，钟南山.呼出气二氧化碳和体表氧饱和度监测在慢性阻塞性肺疾病呼吸衰竭患者中的应用.南方医科大学学报, 2010;30(7):1565-1568.
[6] 马晖，贾玮，李月川等.胸腔气体分析对引流管堵塞气胸患者的治疗价值[J].天津医药，2011,39(6):527-529.
[7] Baumann MH, Strange C, Heffner JE, Light R,KirbyTJ, Klein J, Luketich JD, Panacek EA,Sahn SA: Management of spontaneous pneumothorax.An American College of Chest Physicians.Delphi Consensus Statement. Chest2001;119:590–602.
[8] Henry M, Arnold T, Harvey J.BTS guidelines for themanagement of spontaneous pneumothorax. Thorax 2003;58(Suppl II):ii39 –52.
[9] Teruaki Nishiuma, Hisashi Ohnishi, Naoko Katsurada:Evaluation of Simple Aspiration Therapy in the Initial Treatment for Primary Spontaneous Pneumothorax. Intern Med 2012;51:1329-1333.
[10] 李娜，贾玮，李月川等.细导管排气减压治疗COPD并发气胸的效果研究[J].天津医药，2011,40(5):471-473.