Foo Chuan T, Herre Jurgen
Department of Respiratory Medicine Cambridge University Hospitals NHS Foundation Trust Cambridge UK.
Respirol Case Rep. 2021 May 7;9(6):e00760. doi: 10.1002/rcr2.760. eCollection 2021 Jun.
Haemothorax is an accumulation of blood in the pleural space. Retained haemothorax refers to blood that cannot be drained from the pleural cavity and is associated with an increased risk of empyema and fibrothorax often necessitating surgical evacuation. We describe our experience of using intrapleural fibrinolytic therapy in three patients with different bleeding risk and acute non-traumatic retained haemothorax. The first was a 41-year-old female with disseminated sepsis and an iatrogenic haemothorax, second was a 48-year-old female with transfusion-dependent acute myeloid leukaemia and spontaneous haemothorax, and the third was a 72-year-old female with spontaneous haemothorax from newly diagnosed lung cancer. All patients received one to two doses of intrapleural alteplase without any bleeding complications and resolution of retained haemothorax. This case series demonstrates the successful application and safety of this approach as an alternative to surgery in a well-resourced environment with close monitoring and ready access to blood transfusion.
血胸是指血液在胸腔内积聚。存留性血胸是指无法从胸腔引流出来的血液，其与脓胸和纤维胸的风险增加相关，常需要手术引流。我们描述了在三名具有不同出血风险且患有急性非创伤性存留性血胸的患者中使用胸腔内纤维蛋白溶解疗法的经验。第一名患者是一名41岁女性，患有播散性脓毒症和医源性血胸；第二名患者是一名48岁女性，患有依赖输血的急性髓系白血病并伴有自发性血胸；第三名患者是一名72岁女性，患有新诊断肺癌所致的自发性血胸。所有患者均接受了一至两剂胸腔内阿替普酶治疗，未出现任何出血并发症，存留性血胸也得到了缓解。该病例系列证明了在资源充足、监测密切且能随时进行输血的环境中，这种方法作为手术替代方案的成功应用及安全性。
