自發(fā)性氣胸臨床綜述課件

自發(fā)性氣胸臨床綜述學(xué)習(xí)

ClinicalReiewofSpontaneouspneumothorax河北醫(yī)科大學(xué)第四醫(yī)院胸外科研究生程凈革%程凈革自發(fā)性氣胸臨床綜述學(xué)習(xí)

ClinicalReiewofBMJ河北醫(yī)科大學(xué)第四醫(yī)院胸外科提綱介紹臨床綜述定義和BMJ雜志1自發(fā)性氣胸綜述主要內(nèi)容簡介2Whatcanwelearnfromthispaper?3Wordsandkeysentences4BMJ河北醫(yī)科大學(xué)第四醫(yī)院胸外科提綱介紹臨床綜述定義和BMJ2BMJ河北醫(yī)科大學(xué)第四醫(yī)院胸外科臨床綜述定義ClinicalReiew綜述：綜合敘述；提出總結(jié)或扼要的重述。綜述是指就某一時間內(nèi)，作者針對某一專題，對大量原始研究論文中的數(shù)據(jù)、資料和主要觀點進行歸納整理、分析提煉而寫成的論文。綜述屬三次文獻，專題性強，涉及范圍較小，具有一定的深度和時間性，能反映出這一專題的歷史背景、研究現(xiàn)狀和發(fā)展趨勢，具有較高的情報學(xué)價值。閱讀綜述，可在較短時間內(nèi)了解該專題的最新研究動態(tài)，可以了解若干篇有關(guān)該專題的原始研究論文。國內(nèi)外大多數(shù)醫(yī)學(xué)期刊都辟有綜述欄目。BMJ河北醫(yī)科大學(xué)第四醫(yī)院胸外科臨床綜述定義Clinica3河北醫(yī)科大學(xué)第四醫(yī)院胸外科綜述特點和分類Features1、綜合性；2、評述性；3、先進性；Reiew

Classification1、歸納性綜述2、普通性綜述3、評論性綜述河北醫(yī)科大學(xué)第四醫(yī)院4CompanyLogo

BMJ雜志介紹《英國醫(yī)學(xué)期刊（BMJ）》（周刊）是英國醫(yī)學(xué)會會刊，全球著名的四大主導(dǎo)醫(yī)學(xué)期刊之一。有著160年的悠久歷史，具有深厚的文化積淀和獨特的風(fēng)格特色，在所有綜合性醫(yī)學(xué)期刊中最具綜合性，SCI影響因子高達6—9分。其欄目豐富多彩，述評、新聞、綜述、爭鳴等類型的文章為廣大醫(yī)生所歡迎。其內(nèi)容除了與臨床工作密切相關(guān)的信息與知識外，還涉及與醫(yī)學(xué)相關(guān)的政治、經(jīng)濟、社會、教育、倫理、公共衛(wèi)生等諸多方面。CompanyLogoBMJ雜志介紹《英國醫(yī)學(xué)期刊（BM5河北醫(yī)科大學(xué)第四醫(yī)院胸外科Spontaneouspneumothorax自發(fā)性氣胸1.Whatarethetypesofpneumothorax?2.Howispneumothoraxdiagnosed?3.Whatpredisposestopneumothorax?4.WhatpredictsrecurrenceofPneumothorax?Whatarethetreatmentoptions?SuctionSurgeryPleurodesisObservation研究背景及臨床意義

advice河北醫(yī)科大學(xué)第四醫(yī)院胸外科Spontaneouspneum6w河北醫(yī)科大學(xué)第四醫(yī)院胸外科Background1、Itremainsagloballyimportanthealthproblem,withconsiderableassociatedmorbidityandhealthcarecosts.Withoutpromptmanagementpneumothoraxcan,occasionally,befatal.2.Thisreviewexplorestheepidemiologyandcausesofpneumothoraxanddiscussesdiagnosis,evidencebasedmanagementstrategies,andpossiblefuturedevelopments3.Between1991and1995annualconsultationratesforpneumothoraxinEnglandwerereportedas24/100000formenand9.8/100000forwomen,andadmissionrateswere16.7/100000and5.8/100000,respectively,inastudyanalysingthreenationaldatabasesTextTTTextTextw河北醫(yī)科大學(xué)第四醫(yī)院胸外科Background1、It7河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatarethetypesofpneumothorax?1.Pneumothoraxiscategorisedasprimaryspontaneous,secondaryspontaneous,ortraumatic(iatrogenicorotherwise).2.Thedistinctionbetweenprimaryandsecondarypneumothoraxesisbasedontheabsenceorpresenceofclinicallyapparentlungdisease.3.Tensionpneumothoraxisalifethreateningcomplicationthatrequiresimmediaterecognitionandurgenttreatment.河北醫(yī)科大學(xué)第四醫(yī)院8河北醫(yī)科大學(xué)第四醫(yī)院胸外科Howispneumothoraxdiagnosed?Symptoms【chestpainandbreathlessness】inspiratorychestradiographComputedtomographypneumothorax河北醫(yī)科大學(xué)第四醫(yī)院胸外科Howispneumothor9河北醫(yī)科大學(xué)第四醫(yī)院胸外科Pathogenesis1、

PrimaryPneumothorax：

tobaccosmoking；tallmen.2、

Secondaryspontaneouspneumothorax：COPD；asthma；lungcancer,tuberculosis河北醫(yī)科大學(xué)第四醫(yī)院胸外科Pathogenesis1、Pr10河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatpredictsrecurrenceofpneumothorax?PrimarySmokingcessationistheonlyprovedmodifiableriskfactorforrecurrenceofprimarypneumothorax.SecondaryRatesofrecurrenceofsecondarypneumothoraxarenoticeablyloweredbythoracicsurgery.河北醫(yī)科大學(xué)第四醫(yī)院11河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatarethetreatmentoptions?optionsBECDAObservationHighflowoxygenisrecommendedwhenpatientsareadmittedforobservation.SuctionTheearlyapplicationofsuctionafterdrainageofapneumothoraxshouldbeavoidedbecauseofanincreasedriskofre-expansionpulmonaryoedemaprecipitatedbytherapidreinflationofthecollapsedlungSurgerythoracicsurgeonisadvisedafter48hoursofpersistentairleakageintercostaldraininsertionPleurodesis經(jīng)胸管注入四環(huán)素類藥物和滑石粉等硬化劑，以及手術(shù)過程中用紗布擦拭壁層胸膜或注入硬化劑，可誘發(fā)無菌性胸膜炎癥，使臟層和壁層胸膜粘連，從而消滅胸膜腔間隙，該法稱為胸膜固定術(shù)河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatarethetrea12CompanyLogoDiagramCompanyLo13CompanyLogoDiagramCompanyLo14河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatadvicedopatientsneedafterapneumothorax?2、Smokingcessationsignificantlyreducestherecurrencerateinpatientsafteraninitialprimarypneumothorax,witharelativeriskreductionofover40%.Thereforepatientsshouldbemadeawareofthisandprovidedwithsupporttosuccessfullystopsmoking3、scubadivingshouldbeavoidedindefinitelyafterapneumothoraxunlessadefinitiveproceduresuchassurgicalpleurectomyhasbeenperformed.4、Airtravelshouldnotincreasetheriskofpneumothorax,buttheconsequencesofapneumothoraxwhileairbornearesuchthatpatientsshouldnottraveloncommercialflightswithanundrainedpneumothorax,andairtravelshouldbedelayeduntilafterdefinitiveinterventionoruntilresolutionhasbeenconfirmedradiologically.1、returntoworkandnormalactivityafterresolutionofsymptoms,althoughextremeexertionandcontactsportsshouldbedelayedforlongeranduntilfullradiologicalresolution河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatadvicedopa15河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatnewtreatmentscanbeexpected?1、QuantificationofairleakDigitalthoracicdrainagesystemsallowaquantificationofairleakthatisnotpossiblewithaconventionalunderwaterseal2、EndobronchialvalvesEndobronchialvalveshavebeenutilisedasanon-surgicalmeansofachievingareductioninlungvolumeinemphysema【肺氣腫】andhavealsobeenstudiedasatreatmentforpersistentairleakinpneumothorax3、Bloodpatchthistechniquemaybeusefulasanalternativetochemicalpleurodesisinpatientswithasignificantriskfromsurgery.4、AmbulatorytreatmentHeimlichvalvesareone-wayfluttervalvesthatmaybeattachedtoanintercostaldraininplaceofanunderwaterseal。Theyofferanoutpatienttreatmentoptionforthemanagementofpneumothorax,whichmayhaveanincreasingroleinthefuture河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatnewtreatmen16河北醫(yī)科大學(xué)第四醫(yī)院胸外科Summarypoints1、Primaryspontaneouspneumothoraxisassociatedwithsmokingbutdefinedasoccurringintheabsenceofknownlungdisease。2、Secondaryspontaneouspneumothoraxoccursinthepresenceofknownlungdiseaseandisassociatedwithincreasedsymptoms,morbidity,andratesoftensionpneumothorax.3、Immediaterecognitionandmanagementoftensionpneumothoraxisrequiredtopreventdeath。4、Smokingincreasestheriskofpneumothoraxandratesofrecurrence,andsmokingcessationisstronglyadvised。5、Surgicalinterventioniswarrantedforpatientswithrecurrentpneumothoraxastheriskoffurtherrecurrenceishigh。河北醫(yī)科大學(xué)第四醫(yī)院胸外科Summarypoints1、P17河北醫(yī)科大學(xué)第四醫(yī)院胸外科總結(jié)1、無基礎(chǔ)肺疾病的原發(fā)性自發(fā)性氣胸往往與吸煙相關(guān)。2、繼發(fā)性自發(fā)性氣胸與基礎(chǔ)肺疾病相關(guān)，其癥狀較多較重，并發(fā)癥亦較多，易致張力性氣胸。3、張力性氣胸需要緊急診斷和處理以免死亡。4、吸煙增加氣胸的發(fā)生及復(fù)發(fā)風(fēng)險，故對于氣胸患者應(yīng)推薦戒煙。5、復(fù)發(fā)性氣胸患者再次復(fù)發(fā)可能性較大，故推薦外科手術(shù)治療河北醫(yī)科大學(xué)第四醫(yī)院胸外科總結(jié)1、無基礎(chǔ)肺疾病的原發(fā)性自發(fā)性18河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatcanwelearnfromthispaper?1、自發(fā)性氣胸屬于常見病，能夠從常見病中總結(jié)出來，找出新意，值得我們學(xué)習(xí)。2、本文每一個小題目都是有根據(jù)的，例如【Arecentrandomisedcontrolledtrialof66patientswithprimaryorsecondarypneumothoraxallocatedtominithoracotomyortovideoassistedthoracicsurgeryshowedequivalentrecurrencerates(2.7%and3%,respectively)andpostoperativepain】循證醫(yī)學(xué)體現(xiàn)在每個標(biāo)題中---這也是這篇文章被BMJ收錄的原因3、作為臨床醫(yī)師，經(jīng)常性閱讀本領(lǐng)域的綜述性文章對于盡快把握本領(lǐng)域的科研的方向有幫助，同時也要試著去寫綜述類的文章，盡管Review比不上實驗性Article,但是對于鍛煉閱讀文獻、總結(jié)、轉(zhuǎn)化臨床是有幫助的。河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatcanwelearn19Wordsandkeysentences河北醫(yī)科大學(xué)第四醫(yī)院胸外科1、epidemiology[,ep?di?m?‘?l?d??]n.流行病學(xué)；傳染病學(xué)；2、consultation[k?ns?l'te??(?)n]n.咨詢；磋商；[臨床]會診；討論會3、admissionrates住院率；4、traumatic[tr??‘m?t?k;tra?-]n.外傷藥adj.外傷的；創(chuàng)傷的5、emphysema[,emf?'si?m?]n.[臨床]氣腫；肺氣腫6、cardiopulmonaryreserve心肺功能儲備7、Tensionpneumothorax張力性氣胸8、visceralpleura臟層胸膜parietalpleura壁層胸膜9、midclavicular鎖骨間的clavicular[kl?'vikjul?]adj.鎖骨的10、hemithorax[,hemi'θ?:r?ks]n.[解剖]半胸11、breathlessness['breθlisnis]n.呼吸急促，氣喘吁吁12、tachycardia英[,t?k?'kɑ?d??][,t?k?'kɑrd??]心動過速13、supine[‘s(j)u?pa?n]adj.仰臥的；掌心向上的；向后靠的14、costophrenicadj.肋膈的(胸膜)15、emphysema[,emf?'si?m?]n.[臨床]氣腫；肺氣腫16、bullae['buli:]n.肺大泡（bulla的復(fù)數(shù)）；17、parenchyma[p?'re?k?m?]n.[組織]實質(zhì)；軟細(xì)胞組織18、lungapex['e?peks]n.頂點；尖端19、pulmonaryoedema肺水腫20、interstitiallungdisease肺間質(zhì)疾病Wordsandkeysentences河北醫(yī)科大20sentences河北醫(yī)科大學(xué)第四醫(yī)院1、Itremainsagloballyimportanthealthproblem,withconsiderableassociatedmorbidityandhealthcarecosts。2、Thedistinctionbetweenprimaryandsecondarypneumothoraxesisbasedontheabsenceorpresenceofclinicallyapparentlungdisease.3、Comparedwithminithoracotomy,videoassistedthoracicsurgerywasassociatedwithhigherpatientsatisfaction。4、Themostimportantriskfactorcontributingtoriskofprimarypneumothoraxistobaccosmoking。5、Chronicobstructivepulmonarydiseaseisthemostcommonlungdiseasecausingsecondarypneumothorax,accountingforaround57%ofcases。河21appendix河北醫(yī)科大學(xué)第四醫(yī)院胸外科1、Cochrane協(xié)作網(wǎng)是以已故的英國著名流行病學(xué)家和內(nèi)科醫(yī)生ArchieCochrane(1909/1988)的姓氏命名，在英國合法注冊的一個非贏利性國際學(xué)術(shù)團體。Cochrane協(xié)作網(wǎng)的宗旨是制作、保存和傳播有關(guān)衛(wèi)生保健措施的系統(tǒng)評價，為確保系統(tǒng)評價的質(zhì)量，協(xié)作網(wǎng)成立了由臨床流行病學(xué)家、生物醫(yī)學(xué)統(tǒng)計學(xué)家和醫(yī)學(xué)編輯專家組成的8個方法學(xué)工作組，制作了系統(tǒng)評價手冊“CochraneHandbook”和相關(guān)軟件。2、由于Cochrane系統(tǒng)評價的質(zhì)量高，受到了世界范圍學(xué)術(shù)界或科技信息研發(fā)機構(gòu)、公司等的廣泛重視。因特網(wǎng)上能免費檢索Cochrane系統(tǒng)評價的途徑很多。如通過UpdateSoftware公司網(wǎng)址(http：//)檢索，通過PubMed檢索系統(tǒng)(http：///PubMed)和Cochrane協(xié)作網(wǎng)的網(wǎng)站(http：//)檢索Cochrane系統(tǒng)評價摘要3、循證醫(yī)學(xué)的相關(guān)內(nèi)容，證據(jù)的分類河北22Classifiesthequalityofevidenceinoneoffourgrades河北醫(yī)科大學(xué)第四醫(yī)院胸外科GRADEDEFINITIONHigh⊕⊕⊕⊕Furtherresearchisveryunlikelytochangeourconfidenceintheestimateofeffect.Moderate⊕⊕⊕Furtherresearchislikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandmaychangetheestimate.Low⊕⊕Furtherresearchisverylikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandislikelytochangetheestimate.VeryLow⊕

Anyestimateofeffectisveryuncertain.Classifiesthequalityofevid23IfigurelifeisagiftandIdon'tintendonwastingit.

ThankYou!我覺得生命是一份禮物，我不想浪費它IfigurelifeisagiftandI自發(fā)性氣胸臨床綜述學(xué)習(xí)

ClinicalReiewofSpontaneouspneumothorax河北醫(yī)科大學(xué)第四醫(yī)院胸外科研究生程凈革%程凈革自發(fā)性氣胸臨床綜述學(xué)習(xí)

ClinicalReiewofBMJ河北醫(yī)科大學(xué)第四醫(yī)院胸外科提綱介紹臨床綜述定義和BMJ雜志1自發(fā)性氣胸綜述主要內(nèi)容簡介2Whatcanwelearnfromthispaper?3Wordsandkeysentences4BMJ河北醫(yī)科大學(xué)第四醫(yī)院胸外科提綱介紹臨床綜述定義和BMJ26BMJ河北醫(yī)科大學(xué)第四醫(yī)院胸外科臨床綜述定義ClinicalReiew綜述：綜合敘述；提出總結(jié)或扼要的重述。綜述是指就某一時間內(nèi)，作者針對某一專題，對大量原始研究論文中的數(shù)據(jù)、資料和主要觀點進行歸納整理、分析提煉而寫成的論文。綜述屬三次文獻，專題性強，涉及范圍較小，具有一定的深度和時間性，能反映出這一專題的歷史背景、研究現(xiàn)狀和發(fā)展趨勢，具有較高的情報學(xué)價值。閱讀綜述，可在較短時間內(nèi)了解該專題的最新研究動態(tài)，可以了解若干篇有關(guān)該專題的原始研究論文。國內(nèi)外大多數(shù)醫(yī)學(xué)期刊都辟有綜述欄目。BMJ河北醫(yī)科大學(xué)第四醫(yī)院胸外科臨床綜述定義Clinica27河北醫(yī)科大學(xué)第四醫(yī)院胸外科綜述特點和分類Features1、綜合性；2、評述性；3、先進性；Reiew

Classification1、歸納性綜述2、普通性綜述3、評論性綜述河北醫(yī)科大學(xué)第四醫(yī)院28CompanyLogo

BMJ雜志介紹《英國醫(yī)學(xué)期刊（BMJ）》（周刊）是英國醫(yī)學(xué)會會刊，全球著名的四大主導(dǎo)醫(yī)學(xué)期刊之一。有著160年的悠久歷史，具有深厚的文化積淀和獨特的風(fēng)格特色，在所有綜合性醫(yī)學(xué)期刊中最具綜合性，SCI影響因子高達6—9分。其欄目豐富多彩，述評、新聞、綜述、爭鳴等類型的文章為廣大醫(yī)生所歡迎。其內(nèi)容除了與臨床工作密切相關(guān)的信息與知識外，還涉及與醫(yī)學(xué)相關(guān)的政治、經(jīng)濟、社會、教育、倫理、公共衛(wèi)生等諸多方面。CompanyLogoBMJ雜志介紹《英國醫(yī)學(xué)期刊（BM29河北醫(yī)科大學(xué)第四醫(yī)院胸外科Spontaneouspneumothorax自發(fā)性氣胸1.Whatarethetypesofpneumothorax?2.Howispneumothoraxdiagnosed?3.Whatpredisposestopneumothorax?4.WhatpredictsrecurrenceofPneumothorax?Whatarethetreatmentoptions?SuctionSurgeryPleurodesisObservation研究背景及臨床意義

advice河北醫(yī)科大學(xué)第四醫(yī)院胸外科Spontaneouspneum30w河北醫(yī)科大學(xué)第四醫(yī)院胸外科Background1、Itremainsagloballyimportanthealthproblem,withconsiderableassociatedmorbidityandhealthcarecosts.Withoutpromptmanagementpneumothoraxcan,occasionally,befatal.2.Thisreviewexplorestheepidemiologyandcausesofpneumothoraxanddiscussesdiagnosis,evidencebasedmanagementstrategies,andpossiblefuturedevelopments3.Between1991and1995annualconsultationratesforpneumothoraxinEnglandwerereportedas24/100000formenand9.8/100000forwomen,andadmissionrateswere16.7/100000and5.8/100000,respectively,inastudyanalysingthreenationaldatabasesTextTTTextTextw河北醫(yī)科大學(xué)第四醫(yī)院胸外科Background1、It31河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatarethetypesofpneumothorax?1.Pneumothoraxiscategorisedasprimaryspontaneous,secondaryspontaneous,ortraumatic(iatrogenicorotherwise).2.Thedistinctionbetweenprimaryandsecondarypneumothoraxesisbasedontheabsenceorpresenceofclinicallyapparentlungdisease.3.Tensionpneumothoraxisalifethreateningcomplicationthatrequiresimmediaterecognitionandurgenttreatment.河北醫(yī)科大學(xué)第四醫(yī)院32河北醫(yī)科大學(xué)第四醫(yī)院胸外科Howispneumothoraxdiagnosed?Symptoms【chestpainandbreathlessness】inspiratorychestradiographComputedtomographypneumothorax河北醫(yī)科大學(xué)第四醫(yī)院胸外科Howispneumothor33河北醫(yī)科大學(xué)第四醫(yī)院胸外科Pathogenesis1、

PrimaryPneumothorax：

tobaccosmoking；tallmen.2、

Secondaryspontaneouspneumothorax：COPD；asthma；lungcancer,tuberculosis河北醫(yī)科大學(xué)第四醫(yī)院胸外科Pathogenesis1、Pr34河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatpredictsrecurrenceofpneumothorax?PrimarySmokingcessationistheonlyprovedmodifiableriskfactorforrecurrenceofprimarypneumothorax.SecondaryRatesofrecurrenceofsecondarypneumothoraxarenoticeablyloweredbythoracicsurgery.河北醫(yī)科大學(xué)第四醫(yī)院35河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatarethetreatmentoptions?optionsBECDAObservationHighflowoxygenisrecommendedwhenpatientsareadmittedforobservation.SuctionTheearlyapplicationofsuctionafterdrainageofapneumothoraxshouldbeavoidedbecauseofanincreasedriskofre-expansionpulmonaryoedemaprecipitatedbytherapidreinflationofthecollapsedlungSurgerythoracicsurgeonisadvisedafter48hoursofpersistentairleakageintercostaldraininsertionPleurodesis經(jīng)胸管注入四環(huán)素類藥物和滑石粉等硬化劑，以及手術(shù)過程中用紗布擦拭壁層胸膜或注入硬化劑，可誘發(fā)無菌性胸膜炎癥，使臟層和壁層胸膜粘連，從而消滅胸膜腔間隙，該法稱為胸膜固定術(shù)河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatarethetrea36CompanyLogoDiagramCompanyLo37CompanyLogoDiagramCompanyLo38河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatadvicedopatientsneedafterapneumothorax?2、Smokingcessationsignificantlyreducestherecurrencerateinpatientsafteraninitialprimarypneumothorax,witharelativeriskreductionofover40%.Thereforepatientsshouldbemadeawareofthisandprovidedwithsupporttosuccessfullystopsmoking3、scubadivingshouldbeavoidedindefinitelyafterapneumothoraxunlessadefinitiveproceduresuchassurgicalpleurectomyhasbeenperformed.4、Airtravelshouldnotincreasetheriskofpneumothorax,buttheconsequencesofapneumothoraxwhileairbornearesuchthatpatientsshouldnottraveloncommercialflightswithanundrainedpneumothorax,andairtravelshouldbedelayeduntilafterdefinitiveinterventionoruntilresolutionhasbeenconfirmedradiologically.1、returntoworkandnormalactivityafterresolutionofsymptoms,althoughextremeexertionandcontactsportsshouldbedelayedforlongeranduntilfullradiologicalresolution河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatadvicedopa39河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatnewtreatmentscanbeexpected?1、QuantificationofairleakDigitalthoracicdrainagesystemsallowaquantificationofairleakthatisnotpossiblewithaconventionalunderwaterseal2、EndobronchialvalvesEndobronchialvalveshavebeenutilisedasanon-surgicalmeansofachievingareductioninlungvolumeinemphysema【肺氣腫】andhavealsobeenstudiedasatreatmentforpersistentairleakinpneumothorax3、Bloodpatchthistechniquemaybeusefulasanalternativetochemicalpleurodesisinpatientswithasignificantriskfromsurgery.4、AmbulatorytreatmentHeimlichvalvesareone-wayfluttervalvesthatmaybeattachedtoanintercostaldraininplaceofanunderwaterseal。Theyofferanoutpatienttreatmentoptionforthemanagementofpneumothorax,whichmayhaveanincreasingroleinthefuture河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatnewtreatmen40河北醫(yī)科大學(xué)第四醫(yī)院胸外科Summarypoints1、Primaryspontaneouspneumothoraxisassociatedwithsmokingbutdefinedasoccurringintheabsenceofknownlungdisease。2、Secondaryspontaneouspneumothoraxoccursinthepresenceofknownlungdiseaseandisassociatedwithincreasedsymptoms,morbidity,andratesoftensionpneumothorax.3、Immediaterecognitionandmanagementoftensionpneumothoraxisrequiredtopreventdeath。4、Smokingincreasestheriskofpneumothoraxandratesofrecurrence,andsmokingcessationisstronglyadvised。5、Surgicalinterventioniswarrantedforpatientswithrecurrentpneumothoraxastheriskoffurtherrecurrenceishigh。河北醫(yī)科大學(xué)第四醫(yī)院胸外科Summarypoints1、P41河北醫(yī)科大學(xué)第四醫(yī)院胸外科總結(jié)1、無基礎(chǔ)肺疾病的原發(fā)性自發(fā)性氣胸往往與吸煙相關(guān)。2、繼發(fā)性自發(fā)性氣胸與基礎(chǔ)肺疾病相關(guān)，其癥狀較多較重，并發(fā)癥亦較多，易致張力性氣胸。3、張力性氣胸需要緊急診斷和處理以免死亡。4、吸煙增加氣胸的發(fā)生及復(fù)發(fā)風(fēng)險，故對于氣胸患者應(yīng)推薦戒煙。5、復(fù)發(fā)性氣胸患者再次復(fù)發(fā)可能性較大，故推薦外科手術(shù)治療河北醫(yī)科大學(xué)第四醫(yī)院胸外科總結(jié)1、無基礎(chǔ)肺疾病的原發(fā)性自發(fā)性42河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatcanwelearnfromthispaper?1、自發(fā)性氣胸屬于常見病，能夠從常見病中總結(jié)出來，找出新意，值得我們學(xué)習(xí)。2、本文每一個小題目都是有根據(jù)的，例如【Arecentrandomisedcontrolledtrialof66patientswithprimaryorsecondarypneumothoraxallocatedtominithoracotomyortovideoassistedthoracicsurgeryshowedequivalentrecurrencerates(2.7%and3%,respectively)andpostoperativepain】循證醫(yī)學(xué)體現(xiàn)在每個標(biāo)題中---這也是這篇文章被BMJ收錄的原因3、作為臨床醫(yī)師，經(jīng)常性閱讀本領(lǐng)域的綜述性文章對于盡快把握本領(lǐng)域的科研的方向有幫助，同時也要試著去寫綜述類的文章，盡管Review比不上實驗性Article,但是對于鍛煉閱讀文獻、總結(jié)、轉(zhuǎn)化臨床是有幫助的。河北醫(yī)科大學(xué)第四醫(yī)院胸外科Whatcanwelearn43Wordsandkeysentences河北醫(yī)科大學(xué)第四醫(yī)院胸外科1、epidemiology[,ep?di?m?‘?l?d??]n.流行病學(xué)；傳染病學(xué)；2、consultation[k?ns?l'te??(?)n]n.咨詢；磋商；[臨床]會診；討論會3、admissionrates住院率；4、traumatic[tr??‘m?t?k;tra?-]n.外傷藥adj.外傷的；創(chuàng)傷的5、emphysema[,emf?'si?m?]n.[臨床]氣腫；肺氣腫6、cardiopulmonaryreserve心肺功能儲備7、Tensionpneumothorax張力性氣胸8、visceralpleura臟層胸膜parietalpleura壁層胸膜9、midclavicular鎖骨間的clavicular[kl?'vikjul?]adj.鎖骨的10、hemithorax[,hemi'θ?:r?ks]n.[解剖]半胸11、breathlessness['breθlisnis]n.呼吸急促，氣喘吁吁12、tachycardia英[,t?k?'kɑ?d??][,t?k?'kɑrd??]心動過速13、supine[‘s(j)u?pa?n]adj.仰臥的；掌心向上的；向后靠的14、costophrenicadj.肋膈的(胸膜)15、emphysema[,emf?'si?m?]n.[臨床]氣腫；肺氣腫16、bullae['buli:]n.肺大泡（bulla的復(fù)數(shù)）；17、parench