自發(fā)性氣胸臨床綜述

1、自發(fā)性氣胸臨床綜述學習Clinical Reiew of Spontaneous pneumothorax,河北醫(yī)科大學第四醫(yī)院胸外科研究生程凈革%,程凈革,BMJ,河北醫(yī)科大學第四醫(yī)院胸外科,提綱,,BMJ,河北醫(yī)科大學第四醫(yī)院胸外科,臨床綜述定義 Clinical Reiew,綜述：綜合敘述；提出總結或扼要的重述。綜述是指就某一時間內，作者針對某一專題，對大量原始研究論文中的數據、資料和主要觀點進行歸納整理、分析提煉而寫成的論

2、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、研究現狀和發(fā)展趨勢，具有較高的情報學價值。閱讀綜述，可在較短時間內了解該專題的最新研究動態(tài)，可以了解若干篇有關該專題的原始研究論文。國內外大多數醫(yī)學期刊都辟有綜述欄目。,www.themegallery.com,河北醫(yī)科大學第四醫(yī)院胸外科,綜述特點和分類,,,,,Company Logo,BMJ雜志介紹,《英國醫(yī)學期刊（BMJ）》（周刊）是英

3、國醫(yī)學會會刊，全球著名的四大主導醫(yī)學期刊之一。有著160年的悠久歷史，具有深厚的文化積淀和獨特的風格特色，在所有綜合性醫(yī)學期刊中最具綜合性，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。其內容除了與臨床工作密切相關的信息與知識外，還涉及與醫(yī)學相關的政治、經濟、社會、教育、倫理、公共衛(wèi)生等諸多方面。,,河北醫(yī)科大學第四醫(yī)院胸外科,Spontaneous pneumothorax,w,河北醫(yī)

4、科大學第四醫(yī)院胸外科,Background,www.themegallery.com,河北醫(yī)科大學第四醫(yī)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 dis

5、tinction between primary and secondary pneumothoraxes is based on the absence or presence of clinically apparent lung disease.3. Tension pneumothorax is a life threatening complication that requires immediate recognitio

6、n and urgent treatment.,,河北醫(yī)科大學第四醫(yī)院胸外科,How is pneumothorax diagnosed?,,Symptoms【 chest pain andbreathlessness 】,inspiratory chest radiograph,Computed tomography,pneumothorax,,河北醫(yī)科大學第四醫(yī)院胸外科,Pathogenesis,1、 Primary Pneumo

7、thorax： tobacco smoking；tall men.2、 Secondary spontaneous pneumothorax：COPD； asthma； lung cancer, tuberculosis,www.themegallery.com,河北醫(yī)科大學第四醫(yī)院胸外科,What predicts recurrence of pneumothorax?,Smoking cessation

8、is the only proved modifiable risk factor for recurrence of primary pneumothorax.,Secondary,Rates of recurrence of secondary pneumothorax are noticeably lowered by thoracic surgery.,,河北醫(yī)科大學第四醫(yī)院胸外科,What are the treatmen

9、t options?,www.themegallery.com,Company Logo,Diagram,www.themegallery.com,Company Logo,Diagram,,河北醫(yī)科大學第四醫(yī)院胸外科,What advice do patients need after a pneumothorax?,2、Smoking cessation significantly reduces the recurrence ra

10、te 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 shou

11、ld be avoided indefinitely after 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 pneumot

12、horax while airborne are such that patients should not travel on commercial flights with an undrained pneumothorax, and air travel should be delayed until after definitive intervention or until resolution has beenconfir

13、med 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 resolution,,河北醫(yī)科大學第四醫(yī)院胸外科,What

14、new treatments can be expected?,1、Quantification of air leakDigital thoracic drainage systems allow a quantification of airleak that is not possible with a conventional underwater seal2、Endobronchial valvesEndobronch

15、ial valves have been utilised as a non-surgical meansof achieving a reduction in lung volume in emphysema【肺氣腫】 andhave also been studied as a treatment for persistent air leak inpneumothorax3、Blood patchthis techniq

16、ue may be useful as an alternative to chemical pleurodesis inpatients with a significant risk from surgery.4、Ambulatory treatmentHeimlich valves are one-way flutter valves that may be attachedto an intercostal drain

17、in place of an underwater seal。They offeran outpatient treatment option for the management ofpneumothorax, which may have an increasing role in the future,,河北醫(yī)科大學第四醫(yī)院胸外科,Summary points,1、Primary spontaneous pneumothora

18、x 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,morb

19、idity, and rates of tension pneumothorax.3、Immediate recognition and management of tension pneumothorax is required to prevent death。4、Smoking increases the risk of pneumothorax and rates of recurrence, and smoking ces

20、sation is strongly advised。5、Surgical intervention is warranted for patients with recurrent pneumothorax as the risk of further recurrence is high。,,河北醫(yī)科大學第四醫(yī)院胸外科,總結,1、無基礎肺疾病的原發(fā)性自發(fā)性氣胸往往與吸煙相關。2、繼發(fā)性自發(fā)性氣胸與基礎肺疾病相關，其癥狀較多較重，

21、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)生及復發(fā)風險，故對于氣胸患者應推薦戒煙。5、復發(fā)性氣胸患者再次復發(fā)可能性較大，故推薦外科手術治療,,河北醫(yī)科大學第四醫(yī)院胸外科,What can we learn from this paper?,1、自發(fā)性氣胸屬于常見病，能夠從常見病中總結出來，找出新意，值得我們學習。2、本文每一個小題目都是有根據的，例如【A recent rando

22、mised controlled 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 postopera

23、tive pain】循證醫(yī)學體現在每個標題中---這也是這篇文章被BMJ收錄的原因3、作為臨床醫(yī)師，經常性閱讀本領域的綜述性文章對于盡快把握本領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、轉化臨床是有幫助的。,Words and key sentences,,河北醫(yī)科大學第四醫(yī)院胸外科,1、epidemiology [,ep?di?m?‘?l?d??]

24、 n. 流行病學；傳染病學；2、consultation [k?ns?l'te??(?)n] n. 咨詢；磋商；[臨床] 會診；討論會3、admission rates住院率；4、traumatic [tr??‘mæt?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、cardiopulmonary reserv

25、e心肺功能儲備7、Tension pneumothorax張力性氣胸8、visceral pleura臟層胸膜 parietal pleura壁層胸膜9、midclavicular鎖骨間的clavicular [klæ'vikjul?] adj. 鎖骨的10、hemithorax [,hemi'θ?:ræks] n. [解剖] 半胸11、breathlessness ['b

26、reθlisnis] n. 呼吸急促，氣喘吁吁12、tachycardia 英 [,tæk?'kɑ?d??] [,tæk?'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、b

27、ullae ['buli:] n. 肺大泡（bulla的復數）；17、parenchyma [p?'re?k?m?] n. [組織] 實質；軟細胞組織18、lung apex['e?peks]n. 頂點；尖端19、pulmonary oedema肺水腫20、interstitial lung disease肺間質疾病,sentences,www.themegallery.com,河北醫(yī)科大學第四醫(yī)院,1、

28、It remains a globally important health problem, with considerable associated morbidity and healthcare costs。2、The distinction between primary and secondary pneumothoraxes is based on the absence or presence of clinicall

29、y apparent lung disease.3、Compared with minithoracotomy, video assisted thoracic surgery was associated with higher patient satisfaction。4、The most important risk factor contributing to risk of primarypneumothorax is

30、tobacco smoking。5、Chronic obstructive pulmonary disease is the most commonlung disease causing secondary pneumothorax, accounting foraround 57% of cases。,appendix,www.themegallery.com,河北醫(yī)科大學第四醫(yī)院胸外科,1、Cochrane協(xié)作網是以已故的英

31、國著名流行病學家和內科醫(yī)生Archie Cochrane(1909/1988)的姓氏命名，在英國合法注冊的一個非贏利性國際學術團體。Cochrane協(xié)作網的宗旨是制作、保存和傳播有關衛(wèi)生保健措施的系統(tǒng)評價，為確保系統(tǒng)評價的質量，協(xié)作網成立了由臨床流行病學家、生物醫(yī)學統(tǒng)計學家和醫(yī)學編輯專家組成的8個方法學工作組，制作了系統(tǒng)評價手冊“Cochrane Handbook”和相關軟件。2、由于Cochrane系統(tǒng)評價的質量高，受到了世界范圍學

32、術界或科技信息研發(fā)機構、公司等的廣泛重視。因特網上能免費檢索Cochrane系統(tǒng)評價的途徑很多。如通過Update Software公司網址(http：//www.cochranelibrary.com)檢索，通過PubMed檢索系統(tǒng)(http：//ncbi.nlm.nih.gov/PubMed)和Cochrane協(xié)作網的網站(http：//www.cochrane.org)檢索Cochrane系統(tǒng)評價摘要3、循證醫(yī)學的相關內容，證據