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1、自发性气胸临床综述学习 Clinical Reiew of Spontaneous pneumothorax,河北医科大学第四医院胸外科研究生 程净革%,程净革,BMJ,河北医科大学第四医院胸外科,提纲,BMJ,河北医科大学第四医院胸外科,临床综述定义 Clinical Reiew,综述：综合叙述；提出总结或扼要的重述。 综述是指就某一时间内，作者针对某一专题，对大量原始研究论文中的数据、资料和主要观点进行归纳整理、分析提炼而写成的论文。综述属三次文献，专题性强，涉及范围较小，具有一定的深度和时间性，能反映出这一专题的历史背景、研究现状和发展趋势，具有较高的情报学价值。阅读综述，可在较短时间内
2、了解该专题的最新研究动态，可以了解若干篇有关该专题的原始研究论文。国内外大多数医学期刊都辟有综述栏目。,,河北医科大学第四医院胸外科,综述特点和分类,Company Logo,BMJ杂志介绍,英国医学期刊（BMJ）（周刊）是英国医学会会刊，全球著名的四大主导医学期刊之一。有着160年的悠久历史，具有深厚的文化积淀和独特的风格特色，在所有综合性医学期刊中最具综合性，SCI影响因子高达69分。其栏目丰富多彩，述评、新闻、综述、争鸣等类型的文章为广大医生所欢迎。其内容除了与临床工作密切相关的信息与知识外，还涉及与医学相关的政治、经济、社会、教育、伦理、公共卫生等诸多方面。,河北医科大学第四医院胸外科
3、,Spontaneous pneumothorax,w,河北医科大学第四医院胸外科,Background,,河北医科大学第四医院胸外科,What are the types of pneumothorax?,1.Pneumothorax is categorised as primary spontaneous, secondary spontaneous, or traumatic (iatrogenic or otherwise). 2. The distinction between primary and secondary pneumothoraxes is based on the
4、 absence or presence of clinically apparent lung disease. 3. Tension pneumothorax is a life threatening complication that requires immediate recognition and urgent treatment.,河北医科大学第四医院胸外科,How is pneumothorax diagnosed?,Symptoms【 chest pain and breathlessness 】,inspiratory chest radiograph,Computed
5、tomography,pneumothorax,河北医科大学第四医院胸外科,Pathogenesis,1、 Primary Pneumothorax： tobacco smoking；tall men. 2、 Secondary spontaneous pneumothorax：COPD； asthma； lung cancer, tuberculosis,,河北医科大学第四医院胸外科,What predicts recurrence of pneumothorax?,Smoking cessation is the only proved modifiable risk factor for
6、 recurrence of primary pneumothorax.,Secondary,Rates of recurrence of secondary pneumothorax are noticeably lowered by thoracic surgery.,河北医科大学第四医院胸外科,What are the treatment options?,,Company Logo,Diagram,,Company Logo,Diagram,河北医科大学第四医院胸外科,What advice do patients need after a pneumothorax?,2、Smokin
7、g cessation significantly reduces the recurrence rate in patients after an initial primary pneumothorax, with a relative risk reduction of over 40%. Therefore patients should be made aware of this and provided with support to successfully stop smoking,3、scuba diving should be avoided indefinitely af
8、ter a pneumothorax unless a definitive procedure such as surgical pleurectomy has been performed. 4、Air travel should not increase the risk of pneumothorax, but the consequences of a pneumothorax while airborne are such that patients should not travel on commercial flights with an undrained pneumoth
9、orax, and air travel should be delayed until after definitive intervention or until resolution has been confirmed radiologically.,1、return to work and normal activity after resolution of symptoms, although extreme exertion and contact sports should be delayed for longer and until full radiological r
10、esolution,河北医科大学第四医院胸外科,What new treatments can be expected?,1、Quantification of air leak Digital thoracic drainage systems allow a quantification of air leak that is not possible with a conventional underwater seal 2、Endobronchial valves Endobronchial valves have been utilised as a non-surgical mea
11、ns of achieving a reduction in lung volume in emphysema【肺气肿】 and have also been studied as a treatment for persistent air leak in pneumothorax 3、Blood patch this technique may be useful as an alternative to chemical pleurodesis in patients with a significant risk from surgery. 4、Ambulatory treatment
12、 Heimlich valves are one-way flutter valves that may be attached to an intercostal drain in place of an underwater seal。They offer an outpatient treatment option for the management of pneumothorax, which may have an increasing role in the future,河北医科大学第四医院胸外科,Summary points,1、Primary spontaneous pne
13、umothorax is associated with smoking but defined as occurring in the absence of known lung disease。 2、Secondary spontaneous pneumothorax occurs in the presence of known lung disease and is associated with increased symptoms,morbidity, and rates of tension pneumothorax. 3、Immediate recognition and ma
14、nagement of tension pneumothorax is required to prevent death。 4、Smoking increases the risk of pneumothorax and rates of recurrence, and smoking cessation is strongly advised。 5、Surgical intervention is warranted for patients with recurrent pneumothorax as the risk of further recurrence is high。,河北医
15、科大学第四医院胸外科,总结,1、无基础肺疾病的原发性自发性气胸往往与吸烟相关。 2、继发性自发性气胸与基础肺疾病相关，其症状较多较重，并发症亦较多，易致张力性气胸。 3、张力性气胸需要紧急诊断和处理以免死亡。 4、吸烟增加气胸的发生及复发风险，故对于气胸患者应推荐戒烟。 5、复发性气胸患者再次复发可能性较大，故推荐外科手术治疗,河北医科大学第四医院胸外科,What can we learn from this paper?,1、自发性气胸属于常见病，能够从常见病中总结出来，找出新意，值得我们学习。 2、本文每一个小题目都是有根据的，例如【A recent randomised controll
16、ed trial of 66 patients with primary or secondary pneumothorax allocated to minithoracotomy or to video assisted thoracic surgery showed equivalent recurrence rates (2.7% and 3%, respectively) and postoperative pain】循证医学体现在每个标题中-这也是这篇文章被BMJ收录的原因 3、作为临床医师，经常性阅读本领域的综述性文章对于尽快把握本领域的科研的方向有帮助，同时也要试着去写综述类的文章，尽管Review比不上实验性Article,但是对于锻炼阅读文献、总结、转化临床是有帮助的。,Words and key sentences,河北医科
