Ramanathan Rajesh, Wolfe Luke G, Duane Therese M
Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Am Surg. 2012 Aug;78(8):883-7.
Between 2 and 4.4 per cent of all patients with trauma chest tubes develop retained hemothoraces. Retained hemothoraces prolong chest tube duration and hospital length of stay, and increase infectious complications like empyema. Early surgical drainage of retained hemothoraces has been shown to decrease complications and reduce hospital length of stay. However, the high resource and expertise requirement may limit the widespread applicability of surgical drainage. We present the results of a relatively simple and novel intervention for traumatic hemothoraces undertaken by our faculty to shorten chest tube duration and prevent empyema formation. At our Level I trauma center, 10 trauma patients underwent initial suction evacuation of their traumatic hemothoraces using a sterile suction catheter before chest tube placement. Compared with propensity matched controls, patients that underwent initial suction evacuation experienced significantly shorter chest tube duration (4.2 ± 1.9 vs 5.8 ± 2.3 days, P = 0.04). Also, in this population, there was an 8.2 per cent decrease in the number of patients that developed empyema or required additional drainage. Our study suggests that initial suction evacuation of traumatic hemothoraces is an effective and relatively easy intervention that reduces the duration of chest tube therapy, empyema formation, and the need for additional surgical intervention.
在所有接受创伤性胸腔引流管治疗的患者中，2%至4.4%会出现胸腔积血残留。胸腔积血残留会延长胸腔引流管留置时间和住院时间，并增加诸如脓胸等感染性并发症的发生几率。已证实，早期手术引流胸腔积血残留可减少并发症并缩短住院时间。然而，手术引流对资源和专业技能的高要求可能会限制其广泛应用。我们展示了我们科室针对创伤性血胸采用的一种相对简单且新颖的干预措施的结果，该措施旨在缩短胸腔引流管留置时间并预防脓胸形成。在我们的一级创伤中心，10名创伤患者在放置胸腔引流管之前，先用无菌吸引导管对其创伤性血胸进行了初始吸引排空。与倾向匹配的对照组相比，接受初始吸引排空的患者胸腔引流管留置时间显著缩短（4.2±1.9天对5.8±2.3天，P = 0.04）。此外，在这一人群中，发生脓胸或需要额外引流的患者数量减少了8.2%。我们的研究表明，创伤性血胸的初始吸引排空是一种有效且相对简便的干预措施，可减少胸腔引流管治疗的持续时间、脓胸形成以及额外手术干预的需求。
