Spontaneous pneumothorax yog ib yam mob uas tshwm sim los ntawm kev ua txhaum ntawm kev ncaj ncees ntawm lub pleura. Hauv qhov no, huab cua nkag los ntawm lub ntsws cov ntaub so ntswg mus rau thaj tsam pleural. Cov tsos mob ntawm tus mob pneumothorax tuaj yeem raug cim los ntawm qhov mob hauv siab, thiab ntxiv rau, cov neeg mob muaj kev ua pa luv, tachycardia, pallor ntawm daim tawv nqaij, acrocyanosis, subcutaneous emphysema, thiab lub siab xav ua haujlwm yuam kev.
Raws li ib feem ntawm thawj qhov kev kuaj mob ntawm tus kab mob no, X-rays ntawm lub ntsws thiab kuaj mob pleural puncture tau ua. Txhawm rau tsim kom muaj qhov ua rau ntawm tus kheej pneumothorax (ICD J93.1.), tus neeg mob yuav tsum tau kuaj xyuas qhov tob, piv txwv li, suav tomography lossis thoracoscopy. Cov txheej txheem kev kho mob rau tus kheej pneumothorax cuam tshuam nrog kev tso dej ntawm thaj chaw pleural nrog kev khiav tawm ntawm huab cua nrog rau kev pab cuam video-pab thoracoscopic lossis qhib kev cuam tshuam, uas suav nrog kev tshem tawm ntawm bullae, ntsws resection, thiab lwm yam.
Qhov ua rau mob pneumothorax spontaneous yuav tau tham hauv kab lus no.
Qhov no yog dab tsi?
Raws li tus mob no hauv pulmonologyhais txog tus kheej pneumothorax, uas tsis cuam tshuam nrog kev raug mob lossis iatrogenic kev kho mob thiab kev cuam tshuam kev kuaj mob. Tus kab mob, raws li kev txheeb cais, tshwm sim ntau zaus hauv cov txiv neej, feem ntau ntawm cov neeg muaj hnub nyoog ua haujlwm, uas txiav txim siab tsis yog kev kho mob nkaus xwb, tab sis kuj tseem ceeb rau kev sib raug zoo ntawm cov teeb meem. Nyob rau hauv daim ntawv raug mob thiab iatrogenic ntawm spontaneous pneumothorax, kev sib raug zoo ntawm tus kab mob thiab lwm yam influences yog kom meej meej traced, uas yuav ua tau ntau yam mob hauv siab, puncture ntawm lub pleural kab noj hniav, vein catheterization, pleural biopsy los yog barotrauma. Tab sis nyob rau hauv cov ntaub ntawv ntawm spontaneous pneumothorax, tsis muaj xws li conditionality. Hauv qhov no, kev xaiv ntawm kev kuaj mob kom txaus thiab kev kho mob zoo li yog qhov kev mob siab rau ntawm ib feem ntawm pulmonologists, phthisiatricians thiab thoracic surgeons.
Kev faib tawm
Raws li lub hauv paus ntsiab lus etiological, muaj cov ntaub ntawv tseem ceeb thiab theem nrab ntawm spontaneous pneumothorax (ICD code J93.1.). Thawj hom yog hais tawm tsam keeb kwm yav dhau los ntawm qhov tsis muaj cov ntaub ntawv hais txog kev kho mob tseem ceeb hauv pulmonary pathology. Qhov tshwm sim ntawm daim ntawv thib ob spontaneous tshwm sim los ntawm cov kab mob ntsws concomitant.
Zoo ntawm lub ntsws, muaj ib feem thiab tag nrho tus kheej pneumothorax. Nrog lub ntsws ib nrab, nws poob los ntawm ib feem peb ntawm nws qhov ntim thawj, thiab nrog rau tag nrho ib qho, ntau dua ib nrab.
Raws li qib kev them nyiaj ntawm kev ua pa thiab hemodynamic tsis meej uas nrog rau cov kab mob, muaj peb yam. Cov theem hauv qab no ntawm kev hloov pauv pathological:
- Nyob rau theem them nyiaj.
- Theem them nyiaj ntawm qhov tsis ruaj khov.
- tsis them nyiaj rau theem.
Theem ntawm kev them nyiaj ruaj khov yog pom tom qab spontaneous ib nrab ntim pneumothorax. Nws yog cim los ntawm qhov tsis muaj cov cim qhia ntawm kev ua pa thiab lub plawv tsis ua haujlwm. Cov theem ntawm cov nyiaj tsis ruaj khov yog nrog los ntawm kev txhim kho ntawm tachycardia, thiab ntxiv rau, ua tsis taus pa thaum lub cev tawm dag zog, nrog rau kev txo qis hauv kev ua pa sab nraud, tsis suav nrog. Lub decompensation theem manifests nws tus kheej nyob rau hauv lub xub ntiag ntawm ua tsis taus pa ntawm so, thaum tseem muaj ib tug pronounced tachycardia, microcirculatory cuam tshuam thiab hypoxemia.
Vim txoj kev loj hlob
Primary spontaneous pneumothorax tuaj yeem txhim kho hauv cov tib neeg uas tsis tau kuaj pom kab mob ntsws. Tab sis thaum ua videothoracoscopy lossis thoracotomy hauv pawg neeg mob no, emphysematous bullae nyob subpleurally raug kuaj pom hauv xya caum feem pua ntawm cov neeg mob. Muaj kev sib raug zoo ntawm qhov zaus ntawm tus kheej pneumothorax thiab cov kab ke kev cai ntawm cov neeg mob. Yog li, muab qhov tseem ceeb no, piav qhia pathology feem ntau tshwm sim ntawm cov tub ntxhais hluas nyias thiab siab. Nws tseem tsim nyog sau cia tias kev haus luam yeeb ua rau muaj kev pheej hmoo ntawm tus kab mob mus txog nees nkaum zaug. Dab tsi yog lwm yam ua rau mob pneumothorax?
secondary form
Daim ntawv thib ob ntawm cov kab mob tuaj yeem tsim tawm tsam keeb kwm yav dhau los ntawm ntau yam pathologies ntawm lub ntsws,Piv txwv li, qhov no ua tau nrog mob ntsws asthma, mob ntsws, tuberculosis, rheumatoid mob caj dab, scleroderma, ankylosing spondylitis, malignant neoplasms, thiab hais txog. Yog tias lub ntsws abscess nkag mus rau thaj tsam pleural, raws li txoj cai, pyopneumothorax tsim.
Ntau yam tsis tshua muaj tshwm sim ntawm pneumothorax muaj xws li kev coj khaub ncaws thiab menyuam mos. Menstrual pneumothorax yog txuam nrog lub mis endometriosis thiab tuaj yeem tshwm sim hauv cov poj niam hluas hauv thawj ob hnub tom qab pib kev coj khaub ncaws. Kev pab rau tus mob pneumothorax yuav tsum tau raws sijhawm.
Lub caij nyoog rov tshwm sim ntawm kev coj khaub ncaws pneumothorax, txawm tias nrog kev kho mob ntawm endometriosis, yog li tsib caug feem pua, yog li tam sim tom qab kuaj pom, pleurodesis tau ua los tiv thaiv rov tshwm sim.
Neonatal pneumothorax
Neonatal pneumothorax yog ib daim ntawv uas tshwm sim hauv cov menyuam mos. Hom kab mob no tshwm sim hauv ob feem pua ntawm cov menyuam yaus, feem ntau nws pom hauv cov tub. Tus kab mob no tuaj yeem cuam tshuam nrog qhov teeb meem ntawm lub ntsws nthuav dav lossis muaj cov kab mob ua pa. Tsis tas li ntawd, qhov ua rau mob ntsws pneumothorax tuaj yeem ua rau lub ntsws tawg, ua rau lub cev tsis zoo, thiab lwm yam.
Pathogenesis
Qhov kev mob hnyav ntawm cov qauv kev hloov pauv ncaj qha nyob ntawm lub sijhawm dhau los txij li pib muaj tus kabmob. Tsis tas li ntawd, nws nyob ntawm qhov muaj cov kab mob pathological hauv lub ntsws thiab pleura. Tsis muaj kev cuam tshuam tsawg duaua rau lub zog ntawm cov txheej txheem inflammatory hauv thaj tsam pleural.
Tawm tsam keeb kwm yav dhau los ntawm tus kheej pneumothorax, muaj kev sib txuas lus pulmonary-pleural, uas txiav txim siab qhov nkag mus thiab tsub zuj zuj ntawm huab cua hauv cheeb tsam pleural. Tej zaum kuj yuav muaj ib feem lossis ua tiav ntawm lub ntsws.
Cov txheej txheem inflammatory tshwm sim nyob rau hauv lub pleura plaub teev tom qab spontaneous pneumothorax. Nws yog tus cwj pwm los ntawm qhov muaj hyperemia, kev txhaj tshuaj ntawm cov hlab ntsha pleural thiab tsim ntawm qee qhov exudate. Rau tsib hnub, qhov o ntawm pleura tuaj yeem nce ntxiv, feem ntau qhov no tshwm sim ntawm qhov chaw ntawm nws qhov kev sib cuag nrog cov huab cua. Kuj tseem muaj qhov nce ntxiv ntawm effusion nrog rau qhov poob ntawm fibrin ntawm lub pleural nto. Kev loj hlob ntawm o tuaj yeem nrog kev loj hlob ntawm granulations, thiab, ntxiv rau, fibrous transformation ntawm precipitated fibrin tshwm sim. Lub ntsws tawg yog tsau nyob rau hauv ib qho kev cog lus, yog li nws ua tsis tau tawg. Nyob rau hauv cov ntaub ntawv ntawm tus kab mob, pleural empyema yuav tshwm sim raws sij hawm. Nws tsis suav nrog qhov tsim ntawm bronchopleural fistula, uas yuav txhawb nqa cov txheej txheem ntawm pleural empyema.
Cov tsos mob ntawm pathology
Raws li qhov xwm txheej ntawm cov tsos mob ntawm cov kab mob no, ib hom kab mob pneumothorax thiab latent yog qhov txawv. Qhov xwm txheej tshwm sim tej zaum yuav mob me lossis ua nruj ua tsiv.
Nyob rau hauv ntau lub sijhawm, thawj qhov tshwm sim pneumothorax tuaj yeem tshwm sim tam sim ntawd tawm tsam keeb kwm ntawm kev noj qab haus huv. Thawj zaugfeeb ntawm kev mob, tej zaum yuav muaj ib tug ntse stabbing los yog squeezing mob nyob rau hauv sib thooj ib nrab ntawm lub hauv siab. Nrog rau qhov no, ua tsis taus pa luv tshwm. Qhov hnyav ntawm qhov mob txawv ntawm me me mus rau qhov hnyav heev. Kev mob hnyav tshwm sim thaum sim ua pa tob, thiab, ntxiv rau, thaum hnoos. Mob yuav kis mus rau caj dab, xub pwg, caj npab, plab, lossis sab nraub qaum.
Nyob nruab hnub, qhov mob mob, raws li txoj cai, pom zoo txo qis lossis ploj tag nrho. Kev mob yuav daws tau txawm tias qhov mob pneumothorax (ICD 10 J93.1.) tsis tau daws. Qhov kev xav ntawm kev ua pa tsis zoo, nrog rau qhov tsis muaj cua, tsuas yog tshwm sim thaum lub cev tawm dag zog.
Tawm tsam keeb kwm yav dhau los ntawm kev mob hnyav tshwm sim ntawm pathology, qhov mob tshwm sim nrog ua tsis taus pa luv heev. Tej zaum yuav muaj kev qaug zog luv luv, pallor ntawm daim tawv nqaij, thiab ntxiv rau, tachycardia. Feem ntau ntawm cov neeg mob tib lub sijhawm muaj kev ntshai. Cov neeg mob sim tso lawv tus kheej los ntawm kev txwv lawv txoj kev txav, noj supine txoj hauj lwm. Feem ntau muaj kev txhim kho thiab nce zuj zus ntawm subcutaneous emphysema nrog rau crepitus hauv caj dab, pob tw thiab ceg ceg.
Hauv cov neeg mob uas muaj daim ntawv thib ob ntawm tus kheej pneumothorax, vim muaj qhov txwv txwv ntawm lub plawv, cov kab mob hnyav dua. Cov kev xaiv nyuaj suav nrog kev txhim kho ntawm daim ntawv nruj ntawm pneumothorax nrog rau hemothorax, reactive pleurisy thiab ob sab plhu ntawm lub ntsws. Lub tsub zuj zuj, thiab, ntxiv rau, lub caij nyoog muaj tus kab mobhnoos qeev nyob rau hauv lub ntsws ua rau abscesses, kev loj hlob ntawm theem nrab bronchiectasis, thiab nyob rau hauv tas li ntawd mus rau lub rov tshwm sim ntawm aspiration pneumonia, uas tuaj yeem tshwm sim hauv lub ntsws noj qab haus huv. Cov teeb meem ntawm tus kheej pneumothorax, raws li txoj cai, tsim nyob rau hauv tsib feem pua ntawm cov neeg mob. Lawv tuaj yeem tsim kev hem thawj rau cov neeg mob lub neej.
Kev kuaj mob pneumothorax spontaneous
Kev kuaj xyuas lub hauv siab tuaj yeem qhia qhov smoothness ntawm kev nyem ntawm qhov chaw intercostal, thiab ntxiv rau, txiav txim siab qhov kev txwv ntawm kev mus ncig ua pa. Tsis tas li ntawd, subcutaneous emphysema tuaj yeem pom nrog rau o thiab dilation ntawm caj dab cov leeg. Nyob rau ib feem ntawm lub ntsws uas ploj lawm, tej zaum yuav muaj qhov txo qis hauv lub suab tshee. Thaum lub sij hawm percussion, tympanitis tuaj yeem pom, thiab thaum lub sij hawm auscultation, qhov tsis tuaj yeem ua tiav lossis tsis muaj zog ua pa ntawm lub suab nrov. Dab tsi yog cov lus qhia tseem ceeb rau spontaneous pneumothorax?
Kev saib xyuas ua ntej hauv lub moj khaum ntawm kev kuaj mob yog muab rau cov txheej txheem hluav taws xob. Feem ntau siv hauv siab x-ray thiab fluoroscopy, uas ua rau nws muaj peev xwm los ntsuam xyuas cov huab cua nyob rau hauv lub pleural cheeb tsam nrog rau cov degree ntawm lub cev qhuav dej ntawm lub ntsws, nyob ntawm seb lub localization ntawm spontaneous pneumothorax. Kev tshuaj xyuas x-ray yog nqa tawm tom qab kev kho mob kho mob, txawm tias nws yog puncture lossis kua dej ntawm cov kab noj hniav pleural. Kev kuaj X-ray ua rau nws muaj peev xwm ntsuas qhov ua tau zoo ntawm txoj kev kho mob. Tom qab ntawd, nrog kev pab los ntawm high-resolution xam tomography, nqa tawm nrog rau kev kho magnetic resonance.lub ntsws, nws muaj peev xwm tsim kom muaj qhov tshwm sim ntawm cov kab mob no.
Ib qho kev qhia paub zoo siv hauv kev kuaj mob pneumothorax spontaneous pneumothorax yog thoracoscopy. Nyob rau hauv tus txheej txheem ntawm txoj kev tshawb no, cov kws kho mob tshwj xeeb tswj xyuas cov bullae subpleural nrog rau cov qog los yog tuberculous hloov ntawm lub pleura. Tsis tas li ntawd, kev kuaj ntshav biopsy ntawm cov khoom siv rau kev tshawb fawb morphological tau ua.
Kev mob ntsws pneumothorax, uas muaj cov chav kawm latent lossis tshem tawm, yuav tsum muaj peev xwm sib txawv ntawm qhov muaj cov kab mob bronchopulmonary, thiab ntxiv rau, los ntawm qhov muaj cov diaphragmatic hernia. Nyob rau hauv tas li ntawd, x-ray ntawm txoj hlab pas yog ib qho kev pab zoo rau kev kuaj mob.
Kev kho mob
Cia peb xav txog kev saib xyuas xwm txheej kub ntxhov rau tus mob pneumothorax.
Kev kho tus kab mob yuav tsum, ua ntej ntawm tag nrho, kev khiav tawm sai tshaj plaws ntawm huab cua uas tau sau rau hauv cov kab noj hniav pleural. Cov txheej txheem lees paub dav dav hauv cov tshuaj yog kev hloov pauv ntawm kev kuaj mob mus rau kev ntsuas kho. Tau txais huab cua nyob rau hauv lub moj khaum ntawm thoracocentesis ua ib qho kev qhia rau cov kua dej ntawm lub pleural kab noj hniav. Yog li, cov kua dej pleural tau teeb tsa rau hauv qhov chaw thib ob ntawm qhov chaw nruab nrab ntawm cov kab nruab nrab, tom qab ntawd qhov kev xav tau ua tiav.
Txhim kho ntawm bronchial patency nrog rau kev khiav tawm ntawm cov hnoos qeev nplaum ua rau kev ua haujlwm ntawm kev nthuav dav lub ntsws. Cov neeg mob tau txais kev kho mob bronchoscopy, tracheal aspiration, inhalation nrog mucolytics, ua pa tawm thiab kho cov pa oxygen raws li ib feem ntawm kev kho mob ntawm tus kheej.pneumothorax.
Yog tias lub ntsws tsis nthuav dav li ntawm tsib hnub, cov kws kho mob tshwj xeeb tig mus rau kev siv cov tswv yim phais. Nws, raws li txoj cai, muaj nyob rau hauv kev ua cov thoracoscopic diathermocoagulation ntawm adhesions thiab bullae. Tsis tas li ntawd, hauv kev kho mob ntawm tus kheej pneumothorax, bronchopleural fistulas tuaj yeem raug tshem tawm nrog rau kev siv tshuaj pleurodesis. Nrog rau txoj kev loj hlob ntawm pneumothorax rov tshwm sim, nyob ntawm nws qhov ua rau thiab mob ntawm cov ntaub so ntswg, ib qho atypical marginal ntsws resection, lobectomy, thiab qee zaus pneumonectomy yuav raug tshuaj.
Nrog rau tus mob pneumothorax, kev saib xyuas xwm txheej ceev yuav tsum tau muab tag nrho.
Kev ntsuas rau cov neeg mob uas muaj kab mob no
Nyob rau hauv lub xub ntiag ntawm tus kab mob pneumothorax, qhov tshwm sim feem ntau yog qhov zoo. Raws li kev xyaum qhia tau hais tias, lub ntsws nthuav dav tuaj yeem ua tiav los ntawm cov txheej txheem minimally invasive. Nrog rau kev txhim kho ntawm cov kab mob pneumothorax thib ob, kev rov ua dua ntawm tus kab mob tuaj yeem tshwm sim hauv tsib caug feem pua ntawm cov neeg mob. Uas yuav tsum tau yuav tsum tau tshem tawm ntawm lub hauv paus ua rau, thiab ntxiv rau, nws muaj feem xyuam rau cov kev xaiv ntawm kev kho mob tactics zoo dua. Cov neeg mob uas tau raug mob pneumothorax yuav tsum nyob rau hauv kev saib xyuas nruj ntawm tus kws kho mob pulmonologist lossis tus kws phais mob thoracic txhua lub sijhawm.
Zoo kawg
Yog li, spontaneous pneumothorax yog ib qho mob tshwm sim los ntawm kev nkag mus ntawm huab cua mus rau hauv lub pleural cheeb tsam los ntawm ib puag ncig los ntawm kev ua txhaum ntawm lub ntsej muag.lub ntsws kev ncaj ncees. Qhov no pathology yog sau npe feem ntau ntawm cov txiv neej thaum hluas. Hauv cov poj niam, tus kab mob no tshwm sim tsib zaug tsawg dua. Ua ntej ntawm tag nrho cov, nrog rau kev loj hlob ntawm spontaneous pneumothorax, cov neeg feem ntau yws yws ntawm qhov mob uas tshwm sim nyob rau hauv lub hauv siab. Nyob rau hauv cov ntaub ntawv no, cov neeg mob yuav muaj teeb meem ua pa thiab hnoos, uas, raws li txoj cai, yog qhuav. Tsis tas li ntawd, tej zaum yuav muaj qhov txo qis hauv kev ua haujlwm siab ntev. Tom qab ob peb hnub, lub cev kub tuaj yeem tshwm sim.
Kev kuaj mob feem ntau tsis ua rau muaj teeb meem rau cov kws tshaj lij. Txhawm rau kom paub tseeb tias tus kab mob no, lub hauv siab x-ray yog ua, uas yog ua nyob rau hauv ob qhov projections. Yog tias tsim nyog, kev phais yog ua, uas yog ua raws li kev siv tshuaj loog.
