经皮胸腔造口术联合胸腔灌洗治疗创伤性血胸：一项绩效改进计划。
Percutaneous thoracostomy with thoracic lavage for traumatic hemothorax: a performance improvement initiative.
作者信息
McLauchlan Nathaniel, Ali Ali, Beyer Carl A, Brinson Martha M, Joergensen Sarah M, Yelon Jay, Dumas Ryan Peter, Vella Michael A, Cannon Jeremy W
机构信息
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Trauma Surg Acute Care Open. 2024 Feb 29;9(1):e001298. doi: 10.1136/tsaco-2023-001298. eCollection 2024.
OBJECTIVES
Percutaneously placed small-bore (14 Fr) catheters and pleural lavage have emerged independently as innovative approaches to hemothorax management. This report describes techniques for combining percutaneous thoracostomy with pleural lavage and presents results from a performance improvement series of patients managed with percutaneous thoracostomy with immediate lavage.
METHODS
This was a prospective performance improvement series of patients treated at a level 1 trauma center with percutaneous thoracostomy and immediate lavage between April 2021 and May 2023.
RESULTS
Percutaneous thoracostomy with immediate lavage was used to treat nine hemodynamically normal patients with acute hemothorax. Injuries included both blunt and penetrating mechanisms. 56% of patients presented immediately after injury, and 44% presented in a delayed fashion ranging from 2 to 26 days after injury. Median length of stay was 6 days (IQR 6, 9). Seven patients were discharged home in stable condition, one was discharged to an acute rehabilitation facility, and one was discharged to a skilled nursing facility.
CONCLUSIONS
Percutaneous thoracostomy with pleural lavage is clinically feasible and effective and warrants further evaluation with a multicenter clinical trial.
LEVEL OF EVIDENCE
Therapeutic/care management, level V.
目的
经皮放置的小孔径（14F）导管和胸腔灌洗已分别成为处理血胸的创新方法。本报告描述了将经皮胸腔造口术与胸腔灌洗相结合的技术，并展示了一系列采用经皮胸腔造口术并立即进行灌洗治疗的患者的治疗效果改善情况。
方法
这是一项前瞻性治疗效果改善研究，纳入了2021年4月至2023年5月期间在一级创伤中心接受经皮胸腔造口术并立即进行灌洗治疗的患者。
结果
经皮胸腔造口术并立即进行灌洗用于治疗9例血流动力学正常的急性血胸患者。损伤机制包括钝性伤和穿透伤。56%的患者在受伤后立即就诊，44%的患者延迟就诊，延迟时间为受伤后2至26天。中位住院时间为6天（四分位间距6, 9）。7例患者病情稳定出院，1例转入急性康复机构，1例转入专业护理机构。
结论
经皮胸腔造口术联合胸腔灌洗在临床上可行且有效，值得通过多中心临床试验进行进一步评估。
证据级别
治疗/护理管理，V级。
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