Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5 Fu-Xing Street, Guishan District, Taoyuan City, Taiwan.
Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5 Fu-Xing Street, Guishan District, Taoyuan City, Taiwan.
Injury. 2021 Feb;52(2):225-230. doi: 10.1016/j.injury.2020.12.016. Epub 2020 Dec 24.
Surgery is usually suggested to treat massive haemothorax (MHT). The MHT criteria are based on penetrating trauma observations in military scenarios; the need for surgery in blunt trauma patients remains questionable. This study aimed to determine the characteristics of blunt trauma patients with MHT who required surgery.
Patients who presented to the emergency department (ED) with traumatic haemothorax or pneumothorax, heart and lung injuries, and thoracic blood vessel injuries from Jan 1, 2014, to Dec 31, 2018, were reviewed. The inclusion criterion was a chest tube drainage amount that met the MHT criteria. Therapeutic operations were defined as those involving surgical haemostasis; otherwise, operations were considered non-therapeutic. The non-therapeutic operation group included the patients who received nonoperative management. The characteristics of the therapeutic and non-therapeutic operation groups were compared.
Forty-four patients were enroled in the study. Six patients received conservative treatment and were discharged uneventfully. Eleven patients underwent non-therapeutic operations. The patients with surgical bleeding had a high pulse rate (125.0 (111.0, 135.0) vs. 116.0 (84.0, 121.0) bpm, p = 0.013); low systolic blood pressure (SBP) after resuscitation (106.0 (84.0, 127.0) vs. 121.0 (116.0, 134.0) mmHg, p = 0.040); low pH (7.2 (7.2, 7.3) vs. 7.4 (7.3, 7.4), p = 0.002); and low bicarbonate (17.8 (14.6, 21.5) vs. 21.4 (17.0, 21.5) mEq/L, p = 0.038), low base excess (-9.1 (-13.4, -4.5) vs. -3.8 (-10.1, -0.7), p = 0.028), and high lactate (5.7 (3.3, 7.8) vs. 1.8 (1.7, 2.8) mmol/L, p = 0.002) levels.
Conservative treatment could be performed selectively in patients with MHT. Lactate could be a predictor of the need for surgical intervention in blunt trauma patients with MHT.
外科手术通常被建议用于治疗大量血胸（MHT）。MHT 的标准基于军事场景中穿透性创伤的观察结果；对于钝性创伤患者是否需要手术仍存在疑问。本研究旨在确定需要手术的 MHT 钝性创伤患者的特征。
回顾了 2014 年 1 月 1 日至 2018 年 12 月 31 日期间因创伤性血胸或气胸、心肺损伤和胸血管损伤就诊于急诊科（ED）的患者。纳入标准为胸腔引流量符合 MHT 标准。治疗性手术定义为涉及外科止血的手术；否则，手术被认为是非治疗性的。非治疗性手术组包括接受非手术治疗的患者。比较了治疗性和非治疗性手术组的特征。
本研究共纳入 44 名患者。6 名患者接受保守治疗并顺利出院。11 名患者接受了非治疗性手术。有外科出血的患者脉搏更快（125.0（111.0，135.0）比 116.0（84.0，121.0）bpm，p=0.013）；复苏后收缩压（SBP）更低（106.0（84.0，127.0）比 121.0（116.0，134.0）mmHg，p=0.040）；更低的 pH 值（7.2（7.2，7.3）比 7.4（7.3，7.4），p=0.002）；更低的碳酸氢盐（17.8（14.6，21.5）比 21.4（17.0，21.5）mEq/L，p=0.038），更低的碱剩余（-9.1（-13.4，-4.5）比-3.8（-10.1，-0.7），p=0.028）和更高的乳酸（5.7（3.3，7.8）比 1.8（1.7，2.8）mmol/L，p=0.002）水平。
在 MHT 患者中，可以选择性地进行保守治疗。乳酸可能是预测 MHT 钝性创伤患者是否需要手术干预的指标。
