自发性气胸临床综述课件.pptx

1、LOGO自发性气胸临床综述学习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河北医科大学第四医院胸外科研究生程净革程净革%程净革BMJ河北医科大学第四医院胸外科河北医科大学第四医院胸外科提纲提纲介绍临床综述定义和BMJ杂志1自发性气胸综述主要内容简介2What can we learn from this paper?3Words and key sentences4BMJ河北医科大学第四医院胸外科河北医科大学第四医院胸外科临床综述定义 Clinical Reiewv综述：综述：综合叙述；提出总结或扼要

2、的重述。v 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河北医科大学第四医院胸外科综述特点和分类综述特点和分类Features1、综合性；2、评述性；3、先进性；ReiewClassification1、归纳性综述2、普通性综述3、评论性综

3、述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河北医科大学第四医院胸外科Spontaneous pneumothorax自发自发性气性气胸胸1.Whatarethetypesofpneumothor

4、ax?2.Howispneumothoraxdiagnosed?3.Whatpredisposestopneumothorax?4.WhatpredictsrecurrenceofPneumothorax?Whatarethetreatmentoptions?SuctionSurgeryPleurodesisObservation研究背景及临床意义研究背景及临床意义advice河北医科大学第四医院胸外科河北医科大学第四医院胸外科Background1、It remains a globallyimportant health problem,with considerable associat

5、edmorbidity and healthcare costs.Without prompt managementpneumothorax can,occasionally,be fatal.2.This review explores the epidemiologyand causes of pneumothorax and discusses diagnosis,evidencebased management strategies,and possible future developments3.Between 1991 and 1995 annual consultation r

6、ates forpneumothorax in England were reported as 24/100 000 for menand 9.8/100 000 for women,and admission rates were 16.7/100000 and 5.8/100 000,respectively,in a study analysing threenational databasesTextTTTextText河北医科大学第四医院胸外科河北医科大学第四医院胸外科What are the types of pneumothorax?1.Pneumothorax is cate

7、gorised as primary spontaneous,secondary spontaneous,or traumatic(iatrogenic or otherwise).2.The distinction 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 im

8、mediate recognition and urgent treatment.河北医科大学第四医院胸外科河北医科大学第四医院胸外科How is pneumothorax diagnosed?Symptoms【chest pain andbreathlessness】inspiratory chest radiographComputed tomographypneumothorax河北医科大学第四医院胸外科河北医科大学第四医院胸外科Pathogenesis1、Primary Pneumothorax：tobaccosmoking；tall men.2、Secondary spontaneo

9、us pneumothorax：COPD；asthma；lung cancer,tuberculosis河北医科大学第四医院胸外科河北医科大学第四医院胸外科What predicts recurrence of pneumothorax?Primary Smoking cessation is the only proved modifiable risk factor for recurrence of primary pneumothorax.SecondaryRates of recurrence of secondary pneumothorax are noticeably lowe

10、red by thoracic surgery.河北医科大学第四医院胸外科河北医科大学第四医院胸外科What are the treatment options?optionsObservationHigh flow oxygen is recommended when patients are admitted for observation.SuctionThe early application of suction after drainage of apneumothorax should be avoided because of an increased risk of re-e

11、xpansion pulmonary oedema precipitated by the rapid reinflation of the collapsed lungSurgerythoracic surgeon is advisedafter 48 hours of persistent air leakageintercostaldraininsertionPleurodesis经胸管注入四环素类药物和滑石粉等硬化剂，以及手术过程中用纱布擦拭壁层胸膜或注入硬化剂，可诱发无菌性胸膜炎症，使脏层和壁层胸膜粘连，从而消灭胸膜腔间隙，该法称为胸膜固定术Company LogoDCompany

12、LogoDiagram河北医科大学第四医院胸外科河北医科大学第四医院胸外科What advice do patients need after a pneumothorax?2、Smoking 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 provid

13、ed with support to successfully stop smoking3、scuba diving should 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 pneumothorax while airborne

14、 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 beenconfirmed radiologically.1、return to work and normal activity after resolution of symptoms,although extreme

15、exertion and contact sports should be delayed for longer and until full radiological resolution河北医科大学第四医院胸外科河北医科大学第四医院胸外科What new treatments can be expected?1、QuantificationofairleakDigital thoracic drainage systems allow a quantification of airleak that is not possible with a conventional underwate

16、r seal2、EndobronchialvalvesEndobronchial valves have been utilised as a non-surgical meansof achieving a reduction in lung volume in emphysema【肺气肿】andhave also been studied as a treatment for persistent air leak inpneumothorax3、Bloodpatchthis technique may be useful as an alternative to chemical ple

17、urodesis inpatients with a significant risk from surgery.4、AmbulatorytreatmentHeimlich valves are one-way flutter valves that may be attachedto an intercostal drain in place of an underwater seal。They offeran outpatient treatment option for the management ofpneumothorax,which may have an increasing

18、role in the future河北医科大学第四医院胸外科河北医科大学第四医院胸外科Summary points1、Primary spontaneous pneumothorax 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 sym

19、ptoms,morbidity,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 cessation is strongly advised。5、Surgical intervention is warranted for patien

20、ts with recurrent pneumothorax as the risk of further recurrence is high。河北医科大学第四医院胸外科河北医科大学第四医院胸外科总结总结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河北医科大学第四医院胸外科What can we learn from th

21、is 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 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 postoperative

22、 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河北医科大学第四医院胸外科河北医科大学第四医院胸外科1、epidemiology,epdimld n.流行病学；传染病学；2、consultation knslte()n n.咨询；磋商；临床 会诊；讨论会3、admission rates住院率；4、traumatic trm

23、tk;tra-n.外伤药adj.外伤的；创伤的5、emphysema,emfsim n.临床 气肿；肺气肿6、cardiopulmonary reserve心肺功能储备7、Tension pneumothorax张力性气胸8、visceral pleura脏层胸膜 parietal pleura壁层胸膜9、midclavicular锁骨间的clavicular klvikjul adj.锁骨的10、hemithorax,hemi:rksn.解剖解剖半胸半胸11、breathlessness brelisnis n.呼吸急促，气喘吁吁12、tachycardia英英,tkkd,tkkrd心动过速

24、心动过速13、supines(j)upanadj.仰卧的；掌心向上的；向后靠仰卧的；掌心向上的；向后靠的的14、costophrenicadj.肋膈的(胸膜)15、emphysema,emfsimn.临床临床气肿；肺气肿气肿；肺气肿16、bullae buli:n.肺大泡（bulla的复数）；17、parenchymaprekmn.组织组织实质；软细胞组织实质；软细胞组织18、lung apexepeksn.顶点；尖端19、pulmonary oedema肺水肿20、interstitial lung disease肺间质疾病sentences河北医科大学第四医院河北医科大学第四医院1、It

25、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 clinically apparent lung disease.3、Compared with minithoracotomy,video assisted thoracic surge

26、ry was associated with higher patient satisfaction。4、The most important risk factor contributing to risk of primarypneumothorax is tobacco smoking。5、Chronic obstructive pulmonary disease is the most commonlung disease causing secondary pneumothorax,accounting foraround 57%of cases。appendix河北医科大学第四医院

27、胸外科河北医科大学第四医院胸外科1、Cochrane协作网是以已故的英国著名流行病学家和内科医生Archie Cochrane(1909/1988)的姓氏命名，在英国合法注册的一个非赢利性国际学术团体。Cochrane协作网的宗旨是制作、保存和传播有关卫生保健措施的系统评价，为确保系统评价的质量，协作网成立了由临床流行病学家、生物医学统计学家和医学编辑专家组成的8个方法学工作组，制作了系统评价手册“Cochrane Handbook”和相关软件。2、由于Cochrane系统评价的质量高，受到了世界范围学术界或科技信息研发机构、公司等的广泛重视。因特网上能免费检索Cochrane系统评价的途径很

28、多。如通过Update Software公司网址(http：/)检索，通过PubMed检索系统(http：/ncbi.nlm.nih.gov/PubMed)和Cochrane协作网的网站(http：/www.cochrane.org)检索Cochrane系统评价摘要3、循证医学的相关内容，证据的分类Classifies the quality of evidence in one of four grades河北医科大学第四医院胸外科河北医科大学第四医院胸外科GRADEGRADEDEFINITIONDEFINITIONHighHigh Further research is very unli

29、kely to change our Further research is very unlikely to change our confidence in the estimate of effect.confidence in the estimate of effect.ModerateModerate Further research is likely to have an important impact on Further research is likely to have an important impact on our confidence in the esti

30、mate of effect and may change our confidence in the estimate of effect and may change the estimate.the estimate.LowLow Further research is very likely to have an important Further research is very likely to have an important impact on our confidence in the estimate of effect and is impact on our confidence in the estimate of effect and is likely to change the estimate.likely to change the estimate.Very LowVery Low Any estimate of effect is very uncertain.Any estimate of effect is very uncertain.LOGOI figure life is a gift and I dont intend on wasting it.我觉得生命是一份礼物，我不想浪费它