Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
Am J Surg. 2011 Jun;201(6):766-9. doi: 10.1016/j.amjsurg.2010.04.017.
Intrapleural blood detected by computed tomography scan, but not evident on plain chest radiograph, defines occult hemothorax. This study determined the role for tube thoracostomy.
Hemothorax was quantified on computed tomography by measuring the deepest lamellar fluid stripe at the most dependent portion. Data were collected prospectively on demographics, injury mechanism/severity, chest injuries, mechanical ventilation, hospital length of stay, complications, and outcome. Indications for tube thoracostomy were recorded.
Tube thoracostomy was avoided in 67 patients (83%). Indications for chest tube placement included progression of hemothorax (8), desaturation (4), and delayed hemothorax (2). Patients with intrapleural fluid thickness greater than 1.5 cm were 4 times more likely to require tube thoracostomy.
Occult hemothorax can be managed successfully without tube thoracostomy in most cases. Mechanical ventilation is not an indication for chest tube placement. Accompanying occult pneumothorax may be expected in 50% of cases, but did not affect clinical management.
计算机断层扫描检测到胸腔内有血，但平片胸部 X 线未见明显异常，定义为隐匿性血胸。本研究旨在确定胸腔引流管的作用。
通过测量最易积液部位的最深层液带，在计算机断层扫描上量化血胸。前瞻性收集人口统计学资料、损伤机制/严重程度、胸部损伤、机械通气、住院时间、并发症和结局。记录胸腔引流管的适应证。
67 例（83%）患者避免了胸腔引流管。放置胸腔引流管的适应证包括血胸进展（8 例）、低氧血症（4 例）和迟发性血胸（2 例）。胸腔内积液厚度大于 1.5 厘米的患者需要胸腔引流管的可能性是其 4 倍。
大多数情况下，隐匿性血胸无需胸腔引流管即可成功治疗。机械通气不是放置胸腔引流管的指征。50%的患者可能伴有隐匿性气胸，但不会影响临床处理。
Zotero 插件