普胸术后大量渗血的多因素分析  

The multiplicity analysis of massive hemothorax after thoracic operation

作　　者：李小海[1] 李志强[1] 江涛[1] 陈穗[1] 

机构地区：[1]广州市胸科医院胸外科,510095

出　　处：《中国医师进修杂志（外科版）》2009年第10期20-22,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨普胸术后大量渗血的多种原因及其对策。方法普胸术后大量渗血66例患者，先予非手术治疗，无效则转为开胸止血或清除血块。检测术后24h30例肺叶切除和24例楔形、肺段或未切除肺组织两种术式的残腔大小、胸腔内负压变化和渗血量的相关性。结果非手术治疗有效32例，死亡2例，转为二次手术32例；二次手术后死亡1例，支气管胸膜瘘2例行胸廓成形术后好转，余29例痊愈。楔形、肺段或未切除肺组织与肺叶切除手术相比，残腔大小、胸腔内负压、渗血量均减少（P〈0．05）。结论普胸术后大量渗血主要与术后胸腔内负压变化、创丽小血管乐力上舟、凝血功能异常等因素有关，及时采用适当措施可减少并发症，避免再次开胸。Objective To explore multi-causes and therapy of massive hemothorax after thoracic operation. Methods Sixty-six patients suffered from massive hemothorax after thoracic operation. All of them were executed conservative treatments for postoperative hemothorax. The noneffective cases were executed re-exploration. The relationship of area of residual cavity, fluctuation of intrapleural pressure and volume of hemothorax were analyzed between lobectomy in 30 cases and wedge, segmental or no excision of lung in 24 cases in 24 h postoperation. Results Thirty-two of 66 cases being executed conservative treatments were successful, 2 cases were dead,while 32 cases were executed re-exploration, and 29 of them were cured,but 1 case of them dead,and 2 cases suffered from bronchial fistula,who were cured by thoracoplasty. The operations of wedge, segmental or no excision of lung in 24 eases were compared with lobectomy in 30 cases. It was proved that the former had the smaller area of residual cavity, the lower intrapleural pressure, and the less volume of hemothorax （P 〈 0.05 ）. Conclusions The multiplicity analysis of massive hemothorax after thoracic operation are fluctuation of intrapleural pressure after operation, intracavitary suction with negative pressure, rise of pressure in microcirculation at wound, abnormality of blood coagulation function and so on. It can reduce complications that proper therapy is timely performed,and even avoid of reexploration.

关 键 词：胸外科手术 胸膜腔 血胸 治疗 

分 类 号：R655[医药卫生—外科学] R782.11[医药卫生—临床医学]