Acil Serviste Ani Gelişen Göğüs Ağrısı ve Nefes Darlığı; Spontan Pnömotoraks

Year 2019, Volume: 2 Issue: 2, 5 - 9, 31.07.2019

Selçuk Gürz Hasan Gündoğdu Salih Seymur Mehmetoğlu

Abstract

Giriş: Spontan Pnömotoraks(SP) plevral boşlukta serbest hava birikimi olarak tanımlanır. Ani göğüs ağrısı ve nefes darlığı şikayetiyle acil servise başvuran hastalarda öncelikli olarak akla gelmelidir. SP’ın en önemli tedavi yöntemi cerrahidir. Çalışmamızda acil servise ani göğüs ağrısı ve nefes darlığı ile başvuran hastalarda pnömotoraks ayırıcı tanısını vurgulamayı ve cerrahi yöntemle tedavi edilen SP’ lı olgularımızın değerlendirilmesini amaçladık.

Materyal ve Metod: Ocak 2015 ile Mart 2017 tarihleri arasında Artvin Devlet Hastanesi acil servisine başvuran 35 spontan pnömotoraks olgusu demografik özellikleri, radyolojik evre ve tedavi yöntemlerine göre retrospektif olarak incelendi. Oksijen tedavisi ile takip edilen ve iğne aspirasyonu ile tedavi edilen hastalar çalışma dışı bırakıldı. Hastaların postero-anterior akciğer grafilerinde tespit edilen pnömotoraks değerlendirmesi, American College of Clinical Pharmacy (ACCP)’nin belirlediği ölçüme göre yapılarak 2 gruba ayrıldı. Grup 1; Apikal > 3 cm’den fazla pnömotoraks olan (%50 ve daha fazla) hastalar, Grup 2; apikal < 3 cm’den az pnömotorakslı (%50’ den az) hastalar oldu. Gruplama sonunda primer ve sekonder spontan pnömotorakslı hastalar arasındaki ilişki regresyon ve korelasyon testleri kullanılarak değerlendirildi.

Bulgular: Yaş ortalaması 45,8±5 olan hastaların 30’ u erkek 5’ i kadındı. 26 hasta primer spontan pnömotoraks, 9 hasta sekonder spontan pnömotorakstı. İkili regresyon analizine göre yapılan istatistiksel incelemede akciğer grafisinde ölçülen pnömotoraks miktarının, SP tipine %84 oranıyla bağlı olduğu anlaşıldı.(p<0,01) %50’ den fazla ölçülen pnömotoraks değerinin %87,3 sensitivite ve %89,2 spesifite ile PSP lehine değerlendirileceği ölçüldü. (p<0.01) 24 hasta tüp torakostomiden fayda görürken, 4 hastaya uzamış hava kaçağı nedeniyle ve 7 hastaya rekürren spontan pnömotoraks nedeniyle açık cerrahi veya video-torakoskopik yöntem (VATS) ile bül ligasyonu ve plevral abrazyon yapıldı.

Sonuç: Ani gelişen nefes darlığı ve göğüs ağrısı şikayetiyle acil servise başvuran her hastada spontan pnömotoraks akla gelmelidir. Hasta popülasyonunun az olduğu, tıbbi imkanların sınırlı olduğu hastanelerde, direk radyografi ile SP’ a tanı konulması ve tedavi planlaması çok önemlidir. Spontan pnömotorakslı hastalarda primer tedavi seçeneği tüp torakostomidir. Ancak uzamış hava kaçağı olan ve rekürren spontan pnömotorakslı hastalarda torakotomi yada video-torakoskopik yöntem, cerrahi tedavi için gerekli olabilir.

Keywords

dispne, plevra, pnömotoraks, spontan

Sudden Chest Pain and Shortness of Breath in Emergency Department; Spontaneous Pneumothorax

Abstract

Introduction: Spontaneous Pneumothorax (SP) is defined as the accumulation of free air in the pleural space. It should be considered as a priority in patients consulting the emergency service with sudden chest pain and shortness of breath. In our study, we aimed to emphasize the differential diagnosis of pneumothorax in patients coming to the emergency service with sudden chest pain and shortness of breath. 

Materials and Methods: Thirty five cases of patients with SP admitted to the emergency room of Artvin State Hospital between January 2015 and March 2017 were retrospectively evaluated based on their demographic characteristics, radiological stage and treatment methods. Patients on follow-up with oxygen therapy and those treated with fine needle aspiration were excluded from the study. The pneumothorax evaluation detected in the postero-anterior chest radiographies were tested according to the measurement of American College of Clinical Pharmacy (ACCP) and were divided into two groups. Group 1 consisted of patients with pneumothorax where Apical > 3 cm (50% or more), and Group 2 consisted of patients with less than apical < 3 cm pneumothorax (less than 50%). After the grouping, the relationship between patients with primary and secondary spontaneous pneumothorax was evaluated by using regression and correlation tests.

Results: Thirty were male and 5 were female of the patients whose mean age was 45.8±5. Twenty-six patients had primary spontaneous pneumothorax, and nine had secondary spontaneous pneumothorax. In the statistical study based on double regression analysis, it was seen that the amount of pneumothorax measured on chest X-ray was dependent on the SP type by 84%. It was measured that the pneumothorax value measured over (p<0,01) 50% would support PSP with 87,3% sensitivity and 89,2% specificity (p<0,01). While 24 patients benefited from tube thoracostomy, open surgery or video-thorascopics method (VATS) and bulla ligation and pleural abrasion were conducted on 4 patients due to prolonged air leakage and 7 patients due to recurrent spontaneous pneumothorax.

Conclusion: Spontaneous pneumothorax should be considered in every patient admitted to the emergency department with sudden shortness of breath and chest pain. SP diagnosis through direct radiography and planning for the treatment are very important in hospitals where the patient population is low and medical facilities are limited. Tube thoracostomy is the primary treatment option in patients with spontaneous pneumothorax. However, in patients with prolonged air leakage and recurrent spontaneous pneumothorax, thoracotomy or video-thoracoscopic method may be necessary for surgical treatment.

Keywords

dyspnea, pleura, pneumothorax, spontaneous

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