Careaga G, Esparza J, Riera C, Ramírez-Castañeda A, Ramírez-Castañeda S, Argüero R
Departamento de Cirugía Cardiotorácica. Hospital de Cardiología Centro Médico Nacional Siglo XXI. IMSS. México.
Rev Esp Cardiol. 2001 Mar;54(3):294-8. doi: 10.1016/s0300-8932(01)76311-7.
Coagulated hemothorax is a complication of cardiac surgery with cardiopulmonary bypass. The objective of this study was to present the authors' experience in the intrapleural infusion of streptokinase for the treatment of this complication.
From January 1996 to June 1999, nine patients (6 males, 3 females, age range: 1-75 years) were clinically and radiographically diagnosed with coagulated hemothorax after cardiac surgery. All patients were treated with intrapleural infusion of streptokinase at a standard dose of 250,000 units in adult patients and 12,000 U/kg in pediatric cases. In cases of occluded chest drainage, the position of the patient was changed and drainage was opened.
In all the cases clinical and radiological improvement was observed and 100 to 200 ml of hemothorax was obtained on drainage. One patient died of multiorgan failure due to the underlying disease not related to the procedure. No alteration were observed in hematological tests including coagulation. The other 8 patients were discharged from hospital and remain without pulmonary compromise to date.
Treatment of coagulated hemothorax with intrapleural infusion of streptokinase is a useful procedure and avoid the need for surgical drainage of hemothorax.
凝固性血胸是体外循环心脏手术的一种并发症。本研究的目的是介绍作者采用胸膜腔内注入链激酶治疗该并发症的经验。
1996年1月至1999年6月，9例患者（6例男性，3例女性，年龄范围：1至75岁）在心脏手术后经临床和影像学诊断为凝固性血胸。所有患者均接受胸膜腔内注入链激酶治疗，成人标准剂量为250,000单位，儿童为12,000 U/kg。若胸腔引流管堵塞，则改变患者体位并开放引流。
所有病例均观察到临床和影像学改善，引流出血胸100至200毫升。1例患者因基础疾病而非手术相关原因死于多器官功能衰竭。包括凝血功能在内的血液学检查未发现异常。其他8例患者出院，迄今为止肺部情况良好。
胸膜腔内注入链激酶治疗凝固性血胸是一种有效的方法，可避免进行血胸手术引流。
