Hagiwara Akiyoshi, Yanagawa Youichi, Kaneko Naoyuki, Takasu Akira, Hatanaka Kousuke, Sakamoto Toshihisa, Okada Yoshiaki
Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
J Trauma. 2008 Sep;65(3):589-94. doi: 10.1097/TA.0b013e318181d56a.
To confirm the usefulness of contrast-enhanced computed tomography (CECT) and the efficacy of transcatheter arterial embolization (TAE) in patients, who undergo tube thoracostomy for hemothorax secondary to blunt chest trauma.
CECT was performed at admission in patients, who suffered blunt chest trauma but did not require an emergent thoracotomy. Pulmonary injuries with intrapulmonary hematomas or traumatic pneumatoceles or both on computed tomography images were diagnosed as pulmonary lacerations (PL). The size of the pulmonary injuries with the PL was measured as percent volume (volume of the PL/volume of the lung). Rib fracture displacement was measured on computed tomography images and expressed as parallel and transverse displacement of the fractured ribs (PD and TD, respectively). Patients with an injury to a thoracic great vessel (e.g., aortic injury) were excluded.
CECT of the chest was performed on 154 of 976 consecutive patients with blunt torso trauma. Thirty-four patients have PL without a great vessel injury. Tube thoracostomy was performed at 38 sites in 29 patients. After the initial bloody drainage, the mean drainage during the first hour was 81.2 mL/h +/- 137 mL/h. The mean percent volume of the PL was 29.0% +/- 15.4%. The mean PD was 12.2 mm +/- 10.4 mm. The PD and the TD correlated with the hourly drainage (p = 0.001, p < 0.001, respectively). No correlation was found between the percent volume of PL and hourly drainage (p = 0.11). Of the 38 thoracostomy sites, 6 had a blood loss of > or =200 mL/h. Contrast extravasation on CECT was observed in five of these six sites, and angiography was performed. All five sites had contrast extravasation from an intercostal artery, and TAE was successfully performed.
Intercostal arterial bleeding should be suspected in patients with persistent hemothorax > or =200 mL/h and large displacement of a fractured rib. In such cases, CECT should be performed and TAE is indicated if contrast extravasation is observed.
为证实对比增强计算机断层扫描（CECT）的实用性以及经导管动脉栓塞术（TAE）对因钝性胸部创伤继发血胸而接受胸腔闭式引流术患者的疗效。
对遭受钝性胸部创伤但无需紧急开胸手术的患者在入院时进行CECT检查。计算机断层扫描图像上伴有肺内血肿或创伤性肺气囊或两者皆有的肺损伤被诊断为肺撕裂伤（PL）。将伴有PL的肺损伤大小以体积百分比（PL体积/肺体积）来衡量。在计算机断层扫描图像上测量肋骨骨折移位，并表示为骨折肋骨的平行和横向移位（分别为PD和TD）。排除有胸段大血管损伤（如主动脉损伤）的患者。
在976例连续钝性躯干创伤患者中，154例进行了胸部CECT检查。34例患者有PL且无大血管损伤。29例患者的38个部位进行了胸腔闭式引流术。首次血性引流后，首小时平均引流量为81.2 mL/h±137 mL/h。PL的平均体积百分比为29.0%±15.4%。平均PD为12.2 mm±10.4 mm。PD和TD与每小时引流量相关（分别为p = 0.001，p < 0.001）。未发现PL体积百分比与每小时引流量之间存在相关性（p = 0.11）。在38个胸腔闭式引流部位中，6个部位失血≥200 mL/h。这6个部位中有5个在CECT上观察到造影剂外渗，并进行了血管造影。所有5个部位均有肋间动脉造影剂外渗，且成功进行了TAE。
对于持续性血胸≥200 mL/h且肋骨骨折移位较大的患者，应怀疑肋间动脉出血。在这种情况下，应进行CECT检查，如观察到造影剂外渗则需行TAE。
