Hemothorax: A Review of the Literature.
Hemothorax: A Review of the Literature.
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DOI：
10.1097/cpm.0000000000000343
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发表时间：
2020-01
影响因子：
--
通讯作者：
Cook A
中科院分区：
文献类型：
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作者：
Zeiler J;Idell S;Norwood S;Cook A
血胸是通常由创伤性损伤引起的胸膜腔积血。胸部X光历来是到达医院后的首选成像方式。床旁超声的灵敏度和特异性，特别是通过创伤超声检查扩展病灶评估（eFAST）方案的灵敏度和特异性已经足够重要，足以保证被纳入大多数1级创伤中心作为X线片的辅助手段。如果血胸的大小或严重程度需要介入治疗，胸管造口术一直是并且仍然是治疗的选择。大多数血胸病例可通过胸腔造口术解决。如果胸腔造口术后残留的血液仍留在胸膜腔内，则被认为是残留血胸，有发生脓胸和纤维胸等晚期并发症的重大风险。一旦发生晚期并发症，发病率和死亡率急剧增加，唯一确定的治疗方法是手术。为了避免手术，研究一直集中在清除残留的血胸之前，它的病理进展。最有希望的治疗包括将纤维蛋白溶解剂注入胸膜腔，破坏血胸，允许进一步引流。虽然已经取得了重大进展，但还需要更多的试验来进一步确定纤溶药物在这种情况下的剂量和药代动力学。如果药物治疗和早期手术未能解决残留的血胸，通常需要手术治疗。手术历史上仅包括开胸术，但在非紧急情况下已被视频辅助胸腔镜（VATS）所取代，VATS是一种微创技术，可显着改善患者术后恢复和疼痛。如果所有先前的试图解决血胸失败，那么开胸手术可能是指征。
Hemothorax is a collection of blood in the pleural cavity usually from traumatic injury. Chest X-ray has historically been the imaging modality of choice upon arrival to the hospital. The sensitivity and specificity of point-of-care ultrasound, specifically through the Extended Focal Assessment with Sonography in Trauma (eFAST) protocol has been significant enough to warrant inclusion in most Level 1 trauma centers as an adjunct to radiographs. If the size or severity of a hemothorax warrants intervention, tube thoracostomy has been and still remains the treatment of choice. Most cases of hemothorax will resolve with tube thoracostomy. If residual blood remains within the pleural cavity after tube thoracostomy, it is then considered to be a retained hemothorax, with significant risks for developing late complications such as empyema and fibrothorax. Once late complications occur, morbidity and mortality increase dramatically and the only definitive treatment is surgery. In order to avoid surgery, research has been focused on removing a retained hemothorax before it progresses pathologically. The most promising therapy consists of fibrinolytics which are infused into the pleural space, disrupting the hemothorax, allowing for further drainage. While significant progress has been made, additional trials are needed to further define the dosing and pharmacokinetics of fibrinolytics in this setting. If medical therapy and early procedures fail to resolve the retained hemothorax, surgery is usually indicated. Surgery historically consisted solely of thoracotomy, but has been largely replaced in non-emergent situations by video-assisted thoracoscopy (VATS), a minimally invasive technique that shows considerable improvement in the patients’ recovery and pain post-operatively. Should all prior attempts to resolve the hemothorax fail, then open thoracotomy may be indicated.