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id="0ik2e8q" class="breadcrumb-item"><i class="fa fa-arrow-circle-right"></i> <a href="#">首頁</a></li> <li id="0ik2e8q" class="breadcrumb-item"><a href="http://fengf.cn/doc/release?resourceId=10137&resourceType=2">結(jié)核病防治</a></li> </ol> </nav> </div> <div id="0ik2e8q" class="inside_box details_box"> <h2 class="details_title"> 結(jié)核病防治（ 16 ）肺結(jié)核的嚴(yán)重并發(fā)癥 —談?wù)? </h2> <div id="0ik2e8q" class="details_infos"> <span>發(fā)布時(shí)間：2015-02-16</span> <span>作者：福建省福州肺科醫(yī)院</span> <span>發(fā)布者：福建省福州肺科醫(yī)院</span> <span></span> <span>閱讀 : 230</span> <div id="0ik2e8q" class='sharebox' id="share-2"></div> </div> <div id="0ik2e8q" class="details_cont"> <p><p style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; "> 　肺組織及其臟層胸膜破裂，空氣經(jīng)由支氣管、肺進(jìn)入胸腔，造成肺組織受壓，引起相應(yīng)的病理生理改變，稱自發(fā)性氣胸。發(fā)生氣胸時(shí)，由于胸腔內(nèi)負(fù)壓變成正壓，引起肺臟壓縮，造成不同程度的肺、心功能障礙，嚴(yán)重者可造成呼吸、循環(huán)衰竭甚至死亡。</p> <p style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; "> 　　通常自發(fā)性氣胸按性質(zhì)、部位、范圍、胸腔內(nèi)是否有積液及其性質(zhì)和是否有原發(fā)性疾病來分類。如開放性氣胸、張力性氣胸、閉合性氣胸等等，請(qǐng)?jiān)试S不在這里贅述。</p> <p style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; "> 　　自發(fā)性氣胸起病急驟，好發(fā)于劇烈咳嗽、運(yùn)動(dòng)或猛烈用力后。其癥狀主要有突發(fā)胸痛、胸悶、氣促、呼吸困難及刺激性干咳等。胸痛多為針刺樣或刀割樣，有時(shí)可向肩部、手臂或上腹部放射；少數(shù)病例發(fā)病緩慢時(shí)，只有輕微胸痛。呼吸困難是另一重要癥狀，可與胸痛同時(shí)發(fā)生。其程度依氣胸的類型、發(fā)生的急慢性、肺臟壓縮的程度和原發(fā)性疾病的情況而定。比如，有的病人，原來肺部病變就比較廣泛，肺功能較差，一旦發(fā)生自發(fā)性氣胸，就會(huì)出現(xiàn)明顯的呼吸困難。有的患者還可能伴有紫紺、大汗淋漓、煩躁不安、脈搏細(xì)弱、血壓下降、皮膚濕冷等休克癥狀。咳嗽是誘發(fā)氣胸的重要原因之一。多為干咳，如呼吸困難前有較為劇烈的咳嗽，加上胸痛、呼吸困難等，則應(yīng)考慮是否發(fā)生了自發(fā)性氣胸。</p> <p style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; "> 　　如果患者出現(xiàn)以上癥狀怎么辦？可采取以下措施：</p> <p style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; "> 　　一、緊急救護(hù)：如果患者是在家中，應(yīng)告知 120 請(qǐng)求救治。如肺臟壓縮小于 20% ，無明顯呼吸困難者，也可讓他臥床休息，胸腔里的氣體，有可能借助毛細(xì)血管及淋巴管的回流而自行吸收，但應(yīng)密切觀察，限制活動(dòng)，防止病情進(jìn)展；有呼吸困難或者伴有紫紺者，要給予吸氧，必要時(shí)還可應(yīng)用呼吸興奮劑。有資料表明，吸高濃度的氧氣可加速氣體吸收。因?yàn)樗墒姑?xì)血管內(nèi)氮?dú)夥謮好黠@減低，而其他氣體分壓無變化，這樣可加快氣體吸收速度。不過需用面罩給氧，一般鼻導(dǎo)管給氧難以達(dá)到這樣的效果。</p> <p style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; "> 　　二、抽氣治療：要根據(jù)氣胸類型而確定治療方法。它適用于：肺臟壓縮 20% ～ 30% 的單純性氣胸，無明顯呼吸困難者；張力性氣胸及其他危重氣胸的臨床應(yīng)急措施；肺臟壓縮范圍雖小，但經(jīng)保守治療一周以上未見效者。</p> <p style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; "> 　　抽氣治療應(yīng)由醫(yī)生操作。因?yàn)椋紫纫_定是哪一側(cè)發(fā)生了氣胸；再者，選用什么樣的器材；接著是怎樣進(jìn)針，怎樣避開肋間血管、神經(jīng)等一系列技術(shù)問題。在病情危及生命，患者又難以入院救治，不得不采取抽氣治療時(shí)，可臨時(shí)用 50ml ～ 100ml 注射器，針頭尾部與注射器頭部間連接一小段橡皮管，用血管鉗夾住，在病人患側(cè)鎖骨中線外側(cè)第 2 肋間或腋前線第 4 ～ 5 肋間上沿插入，然后放松血管鉗進(jìn)行抽氣，抽一注射器后，夾住橡皮管，注射器放氣后，按以上方法繼續(xù)再抽，直至患者癥狀改善為止。一般情況下，一次抽氣不應(yīng)超過 2000 ml ，速度也不宜太快，以免發(fā)生肺水腫。應(yīng)該指出，這種療法并不是一種好方法，尤其是對(duì)張力性氣胸、開放性氣胸、老年性氣胸及復(fù)發(fā)性氣胸療效均欠佳，只有在應(yīng)急或不得已時(shí)才用。故現(xiàn)在不少醫(yī)院，尤其是結(jié)核病專科醫(yī)院，已基本使用插管引流或其他更積極的治療方法。</p> <p style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; "> 　　三、整體治療：對(duì)于自發(fā)性氣胸患者，整體治療很重要。首先是針對(duì)病因的有效治療。如果明確氣胸是由肺結(jié)核引起的，那就必須給予合理的抗結(jié)核治療；由慢性支氣管炎、肺氣腫合并感染所致，應(yīng)給予有效的抗感染治療；如果是肺部腫瘤所致，則應(yīng)進(jìn)一步檢查，再作決斷。總之，在這種情況下，都必須住院哪怕是短期住院觀察治療，這樣，才好讓醫(yī)生提供一個(gè)有針對(duì)性的、良好的整體治療方案。</p> <span style="color: rgb(0, 0, 0); font-family: 仿宋_GB2312; font-size: 16px; line-height: 24px; text-align: left; ">　　　　（作者劉坦業(yè) 原載《福建衛(wèi)生報(bào)》 2004 ， 12 ： 27 ）</span></p> </div>  <div id="0ik2e8q" class="details_btn"> <a href="javascript:scroll(0,0)"><img src="assets_front/images/top.gif" alt="返回頂部"></a> <a href="javascript:window.print()"><img src="assets_front/images/print.gif" alt="打印"></a> <a href="javascript:window.close()"><img 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