Tyburski J G, Joseph A L, Thomas G A, Saxe J M, Lucas C E
Department of Surgery, Wayne State University, Detroit, Michigan.
Am Surg. 1993 Sep;59(9):587-9.
Percutaneous central venous catheter access is common-place in surgical patients. Though several major complications of this procedure have been described, pneumothorax is the most common. Pneumothorax is routinely assessed by a chest X-ray within 2 hours after catheter placement. During a recent 6-month interval, the authors identified five patients with delayed onset and diagnosis of pneumothorax following percutaneous central venous access. All immediate post-insertion chest X-rays were normal; however, subsequent chest X-ray showed evidence of pneumothoraxes. The pneumothorax contributed to the death of one patient on positive pressure ventilation. A review of the literature revealed a total of 18 patients in the English literature with this complication. Although the incidence of delayed pneumothorax is low, it is, in some instances, life threatening, particularly in patients on positive pressure ventilation. A high index of suspicion is required to diagnosis and treat this reversible condition.
经皮中心静脉置管在外科患者中很常见。尽管已描述了该操作的几种主要并发症，但气胸是最常见的。气胸通常在置管后2小时内通过胸部X线进行评估。在最近的6个月期间，作者发现了5例经皮中心静脉置管后气胸延迟发生和诊断的患者。所有置管后即刻的胸部X线均正常；然而，随后的胸部X线显示有气胸迹象。气胸导致1例接受正压通气的患者死亡。文献回顾显示，英文文献中共有18例患者出现这种并发症。尽管延迟性气胸的发生率较低，但在某些情况下，它会危及生命，尤其是在接受正压通气的患者中。诊断和治疗这种可逆性疾病需要高度的怀疑指数。
