How to treat spontaneous pneumothorax? What are the conservative treatment methods for pneumothorax?

The pleural cavity is a closed potential space that does not contain gas. When air enters the pleural cavity and causes air accumulation, it is called pneumothorax. So what are the conservative treatment methods for pneumothorax?

(I) General treatment: Generally, bed rest is recommended. If it is the first attack, the condition is mild without obvious breathing difficulties, and lung atrophy is less than 20%, bed rest is sufficient (for patients with good lung function). People with frequent and severe coughing can take cough suppressants (but morphine-like drugs that inhibit the respiratory center are prohibited), avoid heavy lifting, straining to defecate, and strenuous exercise. If the lungs still do not re-expand after a week, other treatments can be used.

(ii) Oxygen inhalation and respiratory stimulants (for those with obvious breathing difficulties and hypoxia)

(III) Gas exhaust therapy: For patients with severe lung collapse, obvious breathing difficulties and cyanosis, severe tuberculosis, patients with mild lung collapse but obvious breathing difficulties, and patients who have not absorbed gas for more than one week, gas should be exhausted immediately.

1. Simple puncture method: generally use a 50-100ml syringe to insert the needle into the affected side between the 2nd and 3rd anterior ribs in the midclavicular line or between the 4th and 5th ribs in the midaxillary line. After disinfection, draw air until the patient's symptoms are relieved. It is mainly used for those with lung compression of 30-50%. It is suitable for closed pneumothorax. If it is tension pneumothorax, the condition is urgent and there is no other suction equipment, a thick needle can be used to pierce the chest cavity to achieve temporary decompression and save the patient from death (there is also a finger sleeve with a hole cut on the tip, which is tied to the needle. When inhaling, the air cannot enter the chest cavity through the needle, and the gas in the chest cavity can be discharged through the needle when exhaling). For localized pneumothorax, the needle insertion site is determined after chest X-ray.

2. Pressure measurement and suction method: Use an artificial pneumothorax device to measure pressure and suction. The suction site is determined based on X-rays. It should be avoided at the site of pleural adhesion to avoid complications such as bleeding and air embolism. If the situation is urgent, puncture and suction can be performed in the most obvious tympanic area after percussion, followed by close observation. The pneumothorax device can measure pressure and draw air to identify the type of pneumothorax, so as to decide whether to intubate or perform conservative treatment. Some closed pneumothorax may become active pneumothorax after drawing air, so close observation is required after drawing air. If necessary, draw air several times more to allow the lung to re-expand quickly. Generally, the amount of air drawn at one time should not exceed 2000ml, and the speed should not be too fast. The intrathoracic pressure should be reduced to about "0" to avoid pulmonary edema.

3. Intercostal intubation and drainage: It has the advantages of immediate relief of symptoms, rapid lung re-expansion, complete elimination of dead space with minimal damage and low recurrence rate. Except for interlobar pneumothorax, it is suitable for almost all types of pneumothorax. Intubation and drainage are the first choice for patients with lung compression > 50%, tension pneumothorax, open pneumothorax with pulmonary insufficiency, contralateral pneumothorax, and multilocular pneumothorax.