Halat Gabriel, Negrin Lukas L, Chrysou Konstantina, Hoksch Beatrix, Schmid Ralph A, Kocher Gregor J
Department of Trauma Surgery, Medical University Vienna, Vienna General Hospital, Austria.
Department of Trauma Surgery, Medical University Vienna, Vienna General Hospital, Austria.
Injury. 2017 Sep;48(9):1895-1899. doi: 10.1016/j.injury.2017.04.061. Epub 2017 May 1.
Precise diagnostics and an adequate therapeutic approach are mandatory in the treatment of air leak in polytrauma patients with blunt chest trauma. The aim of this study was to evaluate the incidence, characteristics, and management of air leak following this injury pattern.
Data from 110 polytrauma patients was collected retrospectively. Fifty-four patients received initial treatment by chest tube placement for pneumothorax. These patients were classified into two groups, one with severe air leak and one with minor air leak. An evaluation of injury pattern, chest wall injuries in particular, duration of air leak, reason for drainage maintenance in place, hospital length of stay, ICU stay, ventilator duration, type of treatment, and the delay to surgical intervention was performed.
Whereas 4 patients showed severe air leak and were subsequently scheduled for timely surgical intervention, the remaining 50 patients only showed minor air leak. Only 7 patients with minor air leak suffered from prolonged air leak (>5days), which spontaneously resolved in all of them after a mean duration of 7.7days (range 6-12days). Absence of a prolonged air leak resulted in a shorter length of stay and a shorter duration of mechanical ventilation, although no statistical significance was observed.
Early spontaneous cessation of most minor air leaks as well as early surgical intervention for severe air leak lead to very satisfactory patient outcomes with a relatively short hospital stay in our patients. We therefore advocate early surgery for lacerations of the pulmonary parenchyma resulting in severe air leak, whereas minor air leaks can usually be treated conservatively.
在治疗钝性胸部创伤的多发伤患者的气胸时，精确的诊断和适当的治疗方法是必不可少的。本研究的目的是评估这种损伤模式后气胸的发生率、特征及处理方法。
回顾性收集110例多发伤患者的数据。54例患者因气胸接受了胸腔闭式引流的初始治疗。这些患者被分为两组，一组为严重气胸，一组为轻度气胸。对损伤模式，特别是胸壁损伤、气胸持续时间、引流管留置原因、住院时间、重症监护病房（ICU）停留时间、机械通气时间、治疗类型以及手术干预延迟时间进行了评估。
4例患者出现严重气胸，随后安排了及时的手术干预，其余50例患者仅出现轻度气胸。只有7例轻度气胸患者气胸持续时间延长（>5天），所有患者气胸均在平均7.7天（范围6 - 12天）后自行缓解。气胸未延长导致住院时间缩短和机械通气时间缩短，尽管未观察到统计学意义。
大多数轻度气胸早期可自行停止，严重气胸早期手术干预可使患者获得非常满意的治疗效果，住院时间相对较短。因此，我们主张对导致严重气胸的肺实质撕裂伤进行早期手术，而轻度气胸通常可保守治疗。
