目前尚无气胸的筛选方法。若临床怀疑气胸,应获得患者的胸片。
当外伤患者有显著胸部外伤时,通常需评估是否患有气胸。因为存在损伤胸内其他结构的风险,通常会考虑选择 CT 扫描对这些患者进行检查。然而,若怀疑不稳定胸部外伤患者患有气胸,在胸片确认前应置入胸管。对创伤性气胸干预的延迟可能会导致患者死亡。[45]Flores HA, Stewart RM. The multiply injured patient. Semin Thorac Cardiovasc Surg. 2008;20:64-68.http://www.ncbi.nlm.nih.gov/pubmed/18420129?tool=bestpractice.com
胸部超声可以仰卧位快速检测多处创伤患者是否存在气胸,因此可作为经验丰富的临床医生的另一种检测手段。[46]Zhang M, Liu ZH, Yang JX, et al. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care. 2006;10:R112.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751015/pdf/cc5004.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/16882338?tool=bestpractice.com 另外,研究也证明超声在检测气胸方面优于胸片,次于 CT 扫描。[47]American College of Radiology. ACR appropriateness criteria: blunt chest trauma. 2013. http://www.acr.org (last accessed 7 September 2017).https://acsearch.acr.org/docs/3082590/Narrative/[48]Kirkpatrick AW, Sirois M, Laupland KB, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma. 2004;57:288-295.http://www.ncbi.nlm.nih.gov/pubmed/15345974?tool=bestpractice.com[49]Soldati G, Testa A, Pignataro G, et al. The ultrasonographic deep sulcus sign in traumatic pneumothorax. Ultrasound Med Biol. 2006;32:1157-1163.http://www.ncbi.nlm.nih.gov/pubmed/16875950?tool=bestpractice.com[50]Alrajab S, Youssef AM, Akkus N, et al. Pleural ultrasound versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013:17;R208.http://ccforum.com/content/17/5/R208http://www.ncbi.nlm.nih.gov/pubmed/24060427?tool=bestpractice.com