自发性气胸临床综述ppt课件.pptx

自发性气胸临床综述学习ClinicalReiewofSpontaneouspneumothorax 提纲 2 临床综述定义ClinicalReiew 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 3 综述特点和分类 4 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6 9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 5 Spontaneouspneumothorax 6 Background 7 Whatarethetypesofpneumothorax 1 Pneumothoraxiscategorisedasprimaryspontaneous secondaryspontaneous ortraumatic iatrogenicorotherwise 2 Thedistinctionbetweenprimaryandsecondarypneumothoraxesisbasedontheabsenceorpresenceofclinicallyapparentlungdisease 3 Tensionpneumothoraxisalifethreateningcomplicationthatrequiresimmediaterecognitionandurgenttreatment 8 Howispneumothoraxdiagnosed Symptoms chestpainandbreathlessness inspiratorychestradiograph Computedtomography pneumothorax 9 Pathogenesis 1 PrimaryPneumothorax tobaccosmoking tallmen 2 Secondaryspontaneouspneumothorax COPD asthma lungcancer tuberculosis 10 Whatpredictsrecurrenceofpneumothorax Smokingcessationistheonlyprovedmodifiableriskfactorforrecurrenceofprimarypneumothorax Secondary Ratesofrecurrenceofsecondarypneumothoraxarenoticeablyloweredbythoracicsurgery 11 Whatarethetreatmentoptions 12 Diagram 13 Diagram 14 Whatadvicedopatientsneedafterapneumothorax 2 Smokingcessationsignificantlyreducestherecurrencerateinpatientsafteraninitialprimarypneumothorax witharelativeriskreductionofover40 Thereforepatientsshouldbemadeawareofthisandprovidedwithsupporttosuccessfullystopsmoking 3 scubadivingshouldbeavoidedindefinitelyafterapneumothoraxunlessadefinitiveproceduresuchassurgicalpleurectomyhasbeenperformed 4 Airtravelshouldnotincreasetheriskofpneumothorax buttheconsequencesofapneumothoraxwhileairbornearesuchthatpatientsshouldnottraveloncommercialflightswithanundrainedpneumothorax andairtravelshouldbedelayeduntilafterdefinitiveinterventionoruntilresolutionhasbeenconfirmedradiologically 1 returntoworkandnormalactivityafterresolutionofsymptoms althoughextremeexertionandcontactsportsshouldbedelayedforlongeranduntilfullradiologicalresolution 15 Whatnewtreatmentscanbeexpected 1 QuantificationofairleakDigitalthoracicdrainagesystemsallowaquantificationofairleakthatisnotpossiblewithaconventionalunderwaterseal2 EndobronchialvalvesEndobronchialvalveshavebeenutilisedasanon surgicalmeansofachievingareductioninlungvolumeinemphysema 肺气肿 andhavealsobeenstudiedasatreatmentforpersistentairleakinpneumothorax3 Bloodpatchthistechniquemaybeusefulasanalternativetochemicalpleurodesisinpatientswithasignificantriskfromsurgery 4 AmbulatorytreatmentHeimlichvalvesareone wayfluttervalvesthatmaybeattachedtoanintercostaldraininplaceofanunderwaterseal Theyofferanoutpatienttreatmentoptionforthemanagementofpneumothorax whichmayhaveanincreasingroleinthefuture 16 Summarypoints 1 Primaryspontaneouspneumothoraxisassociatedwithsmokingbutdefinedasoccurringintheabsenceofknownlungdisease 2 Secondaryspontaneouspneumothoraxoccursinthepresenceofknownlungdiseaseandisassociatedwithincreasedsymptoms morbidity andratesoftensionpneumothorax 3 Immediaterecognitionandmanagementoftensionpneumothoraxisrequiredtopreventdeath 4 Smokingincreasestheriskofpneumothoraxandratesofrecurrence andsmokingcessationisstronglyadvised 5 Surgicalinterventioniswarrantedforpatientswithrecurrentpneumothoraxastheriskoffurtherrecurrenceishigh 17 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 18 Whatcanwelearnfromthispaper 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 Arecentrandomisedcontrolledtrialof66patientswithprimaryorsecondarypneumothoraxallocatedtominithoracotomyortovideoassistedthoracicsurgeryshowedequivalentrecurrencerates 2 7 and3 respectively andpostoperativepain 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 19 Wordsandkeysentences 1 epidemiology ep di m l d n 流行病学 传染病学 2 consultation k ns l te n n 咨询 磋商 临床 会诊 讨论会3 admissionrates住院率 4 traumatic tr m t k tra n 外伤药adj 外伤的 创伤的5 emphysema emf si m n 临床 气肿 肺气肿6 cardiopulmonaryreserve心肺功能储备7 Tensionpneumothorax张力性气胸8 visceralpleura脏层胸膜parietalpleura壁层胸膜9 midclavicular锁骨间的clavicular kl vikjul adj 锁骨的10 hemithorax hemi r ks n 解剖 半胸11 breathlessness bre lisnis n 呼吸急促 气喘吁吁12 tachycardia英 t k k d t k k rd 心动过速13 supine s j u pa n adj 仰卧的 掌心向上的 向后靠的14 costophrenicadj 肋膈的 胸膜 15 emphysema emf si m n 临床 气肿 肺气肿16 bullae buli n 肺大泡 bulla的复数 17 parenchyma p re k m n 组织 实质 软细胞组织18 lungapex e peks n 顶点 尖端19 pulmonaryoedema肺水肿20 interstitiallungdisease肺间质疾病 20 sentences 1 Itremainsagloballyimportanthealthproblem withconsiderableassociatedmorbidityandhealthcarecosts 2 Thedistinctionbetweenprimaryandsecondarypneumothoraxesisbasedontheabsenceorpresenceofclinicallyapparentlungdisease 3 Comparedwithminithoracotomy videoassistedthoracicsurgerywasassociatedwithhigherpatientsatisfaction 4 Themostimportantriskfactorcontributingtoriskofprimarypneumothoraxistobaccosmoking 5 Chronicobstructivepulmonarydiseaseisthemostcommonlungdiseasecausingsecondarypneumothorax accountingforaround57 ofcases 21 appendix 1 Cochrane协作网是以已故的英国著名流行病学家和内科医生ArchieCochrane 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 CochraneHandbook 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