Chang Sung Wook, Ryu Kyoung Min, Ryu Jae-Wook
Trauma Center, Department of Thoracic and Cardiovascular Surgery, Dankook University Hospital, Cheonan, Korea.
Clin Exp Emerg Med. 2018 Mar 30;5(1):60-65. doi: 10.15441/ceem.16.190. eCollection 2018 Mar.
Delayed massive hemothorax requiring surgery is relatively uncommon and can potentially be life-threatening. Here, we aimed to describe the nature and cause of delayed massive hemothorax requiring immediate surgery. Over 5 years, 1,278 consecutive patients were admitted after blunt trauma. Delayed hemothorax is defined as presenting with a follow-up chest radiograph and computed tomography showing blunting or effusion. A massive hemothorax is defined as blood drainage >1,500 mL after closed thoracostomy and continuous bleeding at 200 mL/hr for at least four hours. Five patients were identified all requiring emergency surgery. Delayed massive hemothorax presented 63.6±21.3 hours after blunt chest trauma. All patients had superficial diaphragmatic lacerations caused by the sharp edge of a broken rib. The mean preoperative chest tube drainage was 3,126±463 mL. We emphasize the high-risk of massive hemothorax in patients who have a broken rib with sharp edges.
需要手术治疗的延迟性大量血胸相对少见，且可能危及生命。在此，我们旨在描述需要立即手术的延迟性大量血胸的性质及病因。在5年期间，1278例连续钝性创伤患者入院。延迟性血胸定义为随访胸部X线片和计算机断层扫描显示肋膈角变钝或有胸腔积液。大量血胸定义为胸腔闭式引流术后引流出的血液>1500 mL，且持续出血速度为每小时200 mL至少4小时。共识别出5例均需急诊手术的患者。延迟性大量血胸在钝性胸部创伤后63.6±21.3小时出现。所有患者均有因肋骨骨折锐缘导致的浅表膈肌裂伤。术前胸腔闭式引流的平均引流量为3126±463 mL。我们强调肋骨骨折且边缘锐利的患者发生大量血胸的高风险。
