胸外科护理查房最终版

胸腔镜可以较容易地发 现气胸的病因，操作灵 活，可达叶间裂、肺尖、 肺门，几乎没有盲区， 观察脏层胸膜有无裂口、 胸膜下有无肺大泡及胸 腔内有无粘连带。
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Principles of treatment
治疗原则
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Principles of treatment
1. Conservative treatment 2. Exhaust treatment 3. Operation treatment
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1.Conservative treatment
Mainly applicable to the stability of a small amount of closed pneumothorax Specific methods: strict bedresanalgesic drugs. t ,oxygen ,bronchodilator .bron chospasm, granting the sedative and
1. Fra bibliotekX-ray examination is the most reliable method of diagnosis of pneumothora Typical pneumothorax X-ray findings of the pneumothorax part through the brightness increase, no markings, the pulmonary hilar atrophy, higher density, and the edge of the visible hairline-like visceral pleura shadow; Contralateral lung compensatory emphysema, lung markings; Trachea with Concurrent pleural fluid or blood, fluid levels can be seen. mediastinal shift to the contralateral;
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病例
患者： 余炜成，男，17岁 左侧胸痛、胸闷伴呼吸困难10天。 既往史：既往体健，否认其他重大疾病病史及 药物过敏史。 现病史：患者于10天前无明显诱因，自感左侧 胸痛、胸闷，偶有呼吸困难，无发热、咳嗽、 咳痰、咯血、心慌、乏力、盗汗、声嘶等不适。 起初未予注意，症状持续无明显缓解，胸片检 查，提示：左侧肺组织压缩85%左右。 体格检查： T 37.3 , P 96次/分 , R 20次/ 分 ,BP 140/83mmHg ,神智清楚，皮肤巩膜无黄 染，气管居中，左侧呼吸音稍弱，未明显干湿 罗音。 辅助检查： WBC 11.4 10^9 , N 8.05 , L 18.1 入院诊断： 左侧自发性气胸




2.CT Is more sensitive to the diagnosis of a small amount of gas in the pleural cavity Clearly shows a small amount of pneumothorax and lung tissue overlapping parts of the pneumothorax; Location, extent determine the pleural product gas; May found emphysema blister; Easy to identify the limitations of pneumothorax and lung bullae.
者烦躁不安、大汗、紫绀）
accelerated respiration （呼吸加快），pulse breakdown and even death
（脉搏细数甚至死亡）。
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Signs（体征）：
Fracheal shift to the contralateral（气管向健侧移 位）。 Ipsilateral chest full （患侧胸部饱满）weakening or disappearance of resiratory motion（呼吸运动 减弱或消失）。Percussion drum sound（叩诊呈鼓音）， fremitus and decreased breath sound（语颤呼吸音减 弱）。
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Clinical manifestations
临床表现与体征——蒋娟
Clmical manifestations （临床表现）：
Sudden chest pain（突 然发生胸痛），difficulty in breathing（呼吸困难）， chest tightness(胸闷)， in severe cases irritability、 profusely、cyanosis（严重

此方法可以明了胸膜 表面的情况，易于明 确气胸的病因。当肺 压缩面积在30%～ 40%时行造影为宜， 肺大泡表现为肺叶轮 廓之内单个或多个囊 状低密度影；胸膜裂 口表现为冒泡喷雾现 象，特别是当患者咳 嗽时，由于肺内压增 高，此征象更为明显。
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4.Thoracoscopic

Thoracoscopy can easily detect pneumothorax etiology, flexible operation, can reach the interlobar fissure, apex, hilar, almost no blind spots, observe the visceral pleura with no rips, pleura without bullae of lung and chest cavity with no adhesive joint.




X线检查是诊断气胸最可靠的方 法。 典型的气胸X线表现为气胸部分 透亮度增加，无肺纹理，肺向 肺门萎缩，密度增高，其边缘 可见发线样脏层胸膜阴影； 健侧肺可有代偿性肺气肿，肺 纹理增粗； 气管与纵隔可向健侧移位； 并发胸水或血液时，可见到液 平面。
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Auxiliary examination
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Etiology and classification
病因及分类
THE SPEAKER : 于广平
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The cause of spontaneous pneumothorax
Classification of one
Spontaneous pneumothorax Trauma pneumothorax Artificial pneumothorax
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Auxiliary examination
辅助检查
THE SPEAKER :
桓秀山
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Auxiliary examination
1.X-ray 2.CT 3. Pleural cavity angiography 4. Thoracoscopic
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Auxiliary examination
Thoracic surgery nursing ward round
Spontaneous Pneumothorax
自发性气胸
The speaker : Wuhan Polytechnic University
Group division of labor
Case ------------------------------------- 甄媛媛 Etiology and classification
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CASE
Patient YuWeicheng male 17 years With pain at left chest and difficulty breathing , chest distress 10 days. Past medical history: Always body health , deny history of other serious diseases and drug allergy . History of present disease : Without any obvious cause , he felt pain at the left chest and difficulty breathing , chest distress 10 days ago . No fever , low head , cough , haemoptysis , lack of power , night sweat and so on . At first did not pay attention to these , but symptoms for no ease . A chest radiography showed that the left lung tissue compression by 85% . Physical examination : T 37.3 , P 96/min , R 20/min , BP 140/80 mmHg Intelligence clear , tracheal at the center of neck .The left breath sounds a little weak . Diagnostic examination : WBC 11.4 10^9 , N 8.05 , L 18.1 Admission diagnosis : Spontaneous Pneumothorax
Classification of two
Closed pneumothorax Open pneumothorax Tension pneumothorax
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