目的 探讨心律失常介入治疗术中行锁骨下静脉穿刺引发气胸的危险因素.方法 回顾性分析2010年1月至2014年1月在武汉亚洲心脏病医院接受经导管射频消融术(RFCA)或起搏器植入术行锁骨下静脉穿刺的4 351例患者临床资料.分析发生气胸患者性别、年龄、是否伴发慢性阻塞性肺疾病(COPD)及锁骨形态变化等临床特征,评估是否与气胸发生相关.结果 4 351例患者中共发生气胸47例(1.08％),年龄12～72(47.1±18.4)岁;其中女性37例(78.7％),锁骨与胸骨夹角＜60°者27例,伴有COPD者2例.女性气胸发生率较男性明显增加(OR=2.7,95％CI=1.4～5.2);斜形锁骨即锁骨与胸骨夹角＜60°患者气胸风险明显增加(OR=3.5,95％CI=1.6～7.9),伴有COPD患者气胸概率增加(OR=2.3,95％CI=1.2～4.7).47例中5例气胸未予特殊处理,自行吸收,19例经胸腔穿刺抽气缓解,23例经胸腔闭式引流缓解;均完全康复出院.结论 气胸仍是介入治疗中重要临床问题.女性、有斜形锁骨特征或伴发COPD患者接受锁骨下静脉穿刺时更易发生气胸.%Objective To investigate the risk factors that may induce pneumothorax resulted from subclavian vein puncture during interventional therapy for arrhythmia.Methods The clinical data of 4 351 patients with heart disease,who were admitted to Wuhan Asia Heart Disease Hospital,China,during the period from January 2010 to January 2014 to receive subclavian vein puncture for the performance of radiofrequency catheter ablation or pacemaker implantation,were retrospectively analyzed.The gender,age,presence of chronic obstructive pulmonary disease (COPD) and the shape of clavicle of patients who developed pneumothorax were analyzed,and their relationships with the occurrence of pneumothorax were evaluated.Results Of the 4 351 patients,47 patients developed pneumothorax(1.08％),their age was 12-72 years old with a mean of (47.1±18.4) years old.Among the 47 patients,37 patients were females (78.7％).The angle between clavicle and sternum ＜60°(oblique clavicle) was seen in 27 patients,coexisting COPD was seen in 2 patients.The occurrence of pneumothorax was strikingly higher in females than that in males (OR=2.7,95％ CI=1.4-5.2).In patients with oblique clavicle the risk of pneumothorax was obviously increased (OR=3.5,95％ CI=1.6-7.9) and in patients with COPD the probability of pneumothorax was remarkably increased (OR=2.3,95％CI=1.2-4.7).No special treatment was employed in 5 pneumothorax patients,and the pneumothorax was absorbed by itself.In 19 patients,the pneumothorax was relieved through thoracic puncture and suction.Closed drainage of thoracic cavity was employed in 23 patients.All patients were discharged from hospital with complete rehabilitation.Conclusion Clinically,pneumothorax has been an important clinical problem in interventional therapy.In female patients and in patients who have oblique clavicle or coexisting COPD,pneumothorax is more likely to occur when they receive subclavian vein puncture.
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