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目的探讨老年慢性阻塞性肺病合并自发性气胸的临床特点及诊治方法。方法回顾性分析2006年6月至2011年6月收治的23例老年慢性阻塞性肺病并发自发性气胸患者的临床资料。结果急性起病12例,慢性起病11例,初诊误诊为呼吸衰竭、重症哮喘、肺心病急性发作等9例,误诊率39.1%。3例经绝对卧床休息后复张,5例经2～4次胸腔穿刺抽气后肺复张,12例经胸腔微创闭式引流后肺复张,3例经内科治疗无效者转外科手术治愈。治愈14例,好转7例,2例死于呼吸、心力衰竭并发症,有效率约91.3%。结论老年慢性阻塞性肺疾病合并自发性气胸临床表现缺乏特异性,误诊率较高,易引起呼吸衰竭等严重并发症,临床医生应提高对本病的认识,提高早期诊断率及治愈率,改善患者预后。
Objective To investigate the clinical features and diagnosis and treatment of senile chronic obstructive pulmonary disease complicated with spontaneous pneumothorax. Methods The clinical data of 23 elderly patients with chronic obstructive pulmonary disease complicated with spontaneous pneumothorax admitted from June 2006 to June 2011 were retrospectively analyzed. Results Acute onset in 12 cases, 11 cases of chronic onset, first diagnosis misdiagnosed as respiratory failure, severe asthma, acute attack of pulmonary heart disease in 9 cases, the misdiagnosis rate was 39.1%. 3 cases recovered after absolute bed rest, 5 cases recurred lung after 2 ~ 4 thoracentesis, 12 cases recurred after thoracic minimally invasive closed drainage and 3 cases were surgically treated cure. 14 cases were cured, 7 cases improved, 2 cases died of respiratory and heart failure complications, the effective rate was 91.3%. Conclusions The clinical manifestations of chronic obstructive pulmonary disease complicated with spontaneous pneumothorax in the elderly are lack of specificity, and the misdiagnosis rate is high, which may lead to serious complications such as respiratory failure. Clinicians should raise awareness of the disease, improve the early diagnosis rate and cure rate, improve Patient’s prognosis.