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目的观察中心静脉导管治疗自发性气胸,不同置管深度时肺复张效果及发生意外脱管的差异。方法将2007年1月1日至2007年12月31日因自发性气胸入住呼吸内科、急诊科的患者及住院期间发生自发性气胸的患者共41例,按发生气胸先后顺序随机分入深置管组和浅置管组,以置管治疗后48h时肺完全复张为治疗有效的标准,分析深置管、浅置管两组肺复张效果的差异,同时观察两组发生意外脱管的差异。结果深置管组21例,有效14例,有效率66.67%,浅置管组20例,有效14例,有效率70.00%。深置管组脱管1例,发生率4.76%,浅置管组脱管8例,发生率40.00%。深置管组与浅置管组肺48h复张率相近,两组有效率差异无统计学意义(P>0.05)。同时观察两组意外脱管发生例数,以治疗结束为为观察终点,深置管组较浅置管组脱管发生率低,两组脱管发生率差异有统计学意义(P<0.05)。结论中心静脉导管为软管,刺入胸腔拔出导丝后其位置并不固定,已经过多名患者的正、侧位胸片证实,导管头部可能处于胸腔的上、中,肺前、后等各个部位,是否与导管进入的方向有关有待研究,导管是否有游离于气体聚集处的倾向尚无证据。深置管组与浅置管组肺复张效果接近,可尽量采取深置管的方法治疗自发性气胸,同时减少意外脱管的发生。
Objective To observe the effect of central venous catheter on spontaneous pneumothorax and the effects of pulmonary reexpansion and accidental catheter ablation under different catheterization depths. Methods From January 1, 2007 to December 31, 2007, 41 patients with spontaneous pneumothorax admitted to Department of Respiratory Medicine and Emergency Department due to spontaneous pneumothorax and spontaneous pneumothorax during hospitalization were randomly divided into deep-seated Tube group and shallow tube group, with complete reaeration of lungs 48h after treatment as the effective standard of treatment, analysis of deep and shallow catheterization of the difference between the two groups of lung recruitment, while the accidental detachment of two groups were observed The difference. Results In 21 cases, the effective depth was 14 cases, the effective rate was 66.67%, the shallow catheter group was 20, the effective rate was 14, and the effective rate was 70.00%. One case of deep tube detachment, the incidence of 4.76%, shallow tube detachment in 8 cases, the incidence of 40.00%. There was no significant difference in the effective rate between the two groups (P> 0.05). At the same time, the number of cases of accidental debridement was observed. The end of treatment was regarded as the end point of observation. The incidence of dethronation in the shallow catheterization group was lower than that in the shallow catheterization group, and there was significant difference between the two groups (P <0.05) . Conclusions The central venous catheter is a flexible tube. The position of the central venous catheter is not fixed after it is inserted into the thoracic cavity. It has been confirmed by the positive and lateral radiographs of the patients that the head of the catheter may be in the upper, middle and anterior lung, After various other parts, whether the direction with the catheter to be studied, the catheter has no tendency to leave the gas accumulation there is no evidence. Deep hypothyroidism group and shallow catheter group pulmonary reversion close, try to take deep catheterization treatment of spontaneous pneumothorax, while reducing the incidence of accidental catheter off.