CAJ | 학술논문

目的探讨有色盐水气道内注射,定位闭合性气胸肺漏气靶支气管的方法,并评价其有效性和安全性.方法闭合性自发性气胸34例,其中原发性25例,继发性9例,均经胸腔闭式引流术治疗2～6周[平均(3.0±1.6)周]无效.纤支镜直视下,将适量有色盐水缓缓注射到可疑肺漏气段支气管,注射结束后清理溢出的有色盐水,退出纤支镜.若胸腔引流管出现有色盐水,提示肺漏气靶段支气管.结果肺漏气靶支气管定位成功24例,定位单段支气管21例,累及相邻多段3例.靶支气管定位平均(11±7)h.有色盐水平均(40±15) ml/段支气管.定位操作后靶支气管黏膜完整,无黏膜充血、水肿、出血等损伤,生命体征平稳.有色盐水定位后气胸自愈3例,生物蛋白胶封堵成功21例.生物蛋白胶靶性咳嗽、肺不张各2例,胸腔出血1例,盐水定位靶性发热2例.结论支气管镜直视下,经导管气道内有色盐水注射,能准确定位闭合性气胸肺漏气靶支气管.该方法简单、价廉、安全和有效.
목적 탐토유색염수기도내주사,정위폐합성기흉폐루기파지기관적방법,병평개기유효성화안전성.방법 폐합성자발성기흉34례,기중원발성25례,계발성9례,균경흉강폐식인류술치료2～6주[평균(3.0±1.6)주]무효.섬지경직시하,장괄량유색염수완완주사도가의폐루기단지기관,주사결속후청리일출적유색염수,퇴출섬지경.약흉강인류관출현유색염수,제시폐루기파단지기관.결과 폐루기파지기관정위성공24례,정위단단지기관21례,루급상린다단3례.파지기관정위평균(11±7)h.유색염수평균(40±15) ml/단지기관.정위조작후파지기관점막완정,무점막충혈、수종、출혈등손상,생명체정평은.유색염수정위후기흉자유3례,생물단백효봉도성공21례.생물단백효파성해수、폐불장각2례,흉강출혈1례,염수정위파성발열2례.결론 지기관경직시하,경도관기도내유색염수주사,능준학정위폐합성기흉폐루기파지기관.해방법간단、개렴、안전화유효.
Objective To establish a new method for locating the target bronchus with air leakage in closed pneumothorax injecting colored saline and to evaluate its efficacy and safety.Method 34 patients with closed pneumothorax,25 with spontaneous pneumothorax and 9 with secondary pneumothorax,were included for this study.All cases had been undergoing closed thoracic drainage for 2-6 (3.0 ± 1.6) weeks with no effect.Appropriate volume of colored saline was injected into suspicious segmental bronchi with air leakage through a catheter under bronchoscope;the overflowed colored saline was cleaned;then the bronchoscope was withdrew.The target bronchus with air leakage was located successfully if colored saline was observed in the intercostal drainage tube.Results The target bronchus with air leakage had been successfully located in 24 cases;of which,single segmental bronchi were located in 21 cases and adjacent multi-segmental bronchi in 3 cases.The average time of locating the bronchus with air leakage was (11±7) h.The average dose of colored saline injecting into one segmental bronchi was (40±15)ml.After the procedure of location,the bronchial mucosa showed integrity,with no mucosal hyperemia,edema,or hemorrhage,and vital signs of all cases were stable.3 cases were self-cured after injecting colored saline and 21 cases were successfully occluded by fibrin glue.Cough associated with biological protein occurred in 2 cases,atelectasis in 2,fever associated with colored saline in 2,and pleural hemorrhage in 1.Conclusions Injecting colored saline into airway through catheter under bronchoscope can locate the target bronchus with air leakage in closed pneumothorax precisely.It is simple,cheap,safe,and effective.