Karavis Miltiades Y, Argyra Erifili, Segredos Venieris, Yiallouroy Aneza, Giokas Georgios, Theodosopoulos Thedosios
Filoktitis Rehabilitation Center, Athens, Greece.
Aretaieion Hospital, Athens Medical School, Athens, Greece.
Acupunct Med. 2015 Jun;33(3):237-41. doi: 10.1136/acupmed-2014-010700. Epub 2015 Mar 19.
This paper reports a rare iatrogenic complication of acupuncture-induced haemothorax and comments on the importance and need for special education of physicians and physiotherapists in order to apply safe and effective acupuncture treatment. A 37-year-old healthy woman had a session of acupuncture treatments for neck and right upper thoracic non-specific musculoskeletal pain, after which she gradually developed dyspnoea and chest discomfort. After some delay while trying other treatment, she was eventually transferred to the emergency department where a chest X-ray revealed a right pneumothorax and fluid collection. She was admitted to hospital and a chest tube inserted into the right hemithorax (under ultrasound guidance) drained 800 mL of bloody fluid (haematocrit (Hct) 17.8%) in 24 h and 1200 mL over the following 3 days. Her blood Hct fell from 39.0% to 30.8% and haemoglobin from 12.7 to 10.3 g/dL. The patient recovered completely and was discharged after 9 days of hospitalisation. When dyspnoea, chest pain and discomfort occur during or after an acupuncture treatment, the possibility of secondary (traumatic) pneumo- or haemopneumothorax should be considered and the patient should remain under careful observation (watchful waiting) for at least 48 h. To maximise the safety of acupuncture, specific training should be given for the safe use of acupuncture points of the anterior and posterior thoracic wall using dry needling, trigger point acupuncture or other advanced acupuncture techniques.
本文报告了一例罕见的针灸引起血胸的医源性并发症，并就医生和物理治疗师接受特殊教育以应用安全有效的针灸治疗的重要性和必要性发表了评论。一名37岁的健康女性因颈部和右胸上部非特异性肌肉骨骼疼痛接受了一次针灸治疗，之后她逐渐出现呼吸困难和胸部不适。在尝试其他治疗延误一段时间后，她最终被转到急诊科，胸部X光显示右气胸和胸腔积液。她被收治入院，在右半胸插入一根胸管（在超声引导下），24小时内引出800毫升血性液体（血细胞比容（Hct）17.8%），接下来3天又引出1200毫升。她的血液Hct从39.0%降至30.8%，血红蛋白从12.7降至10.3克/分升。患者完全康复，住院9天后出院。当在针灸治疗期间或之后出现呼吸困难、胸痛和不适时，应考虑继发性（创伤性）气胸或血气胸的可能性，患者应至少接受48小时的密切观察（密切等待）。为了最大限度地提高针灸的安全性，应针对使用干针、触发点针灸或其他先进针灸技术安全针刺胸壁前后部穴位进行专门培训。
