纤维支气管镜代胸腔镜联合尿激酶治疗外伤性凝固血胸

Treatment of traumatic clotted homothorax by combining fibre bronchoscope with intrapleural fibrinolytic urokinase

目的观察纤维支气管镜代胸腔镜联合尿激酶治疗外伤性凝固血胸的疗效,并评估其安全性。方法选择17例外伤性凝固血胸病人,于伤后3￣15日内应用该疗法,观察记录每日引流量,统计应用前后凝血酶原时间、部分活化凝血活酶时间、血小板数量变化,观察治愈率、治疗后平均住院天数、平均尿激酶用量,并将结果与文献资料比较,分析该法优缺点。结果17例病人治愈15例,治愈率88.2%(15/17),与文献资料对比差别无统计学意义(P>0.05)。1例(5.9%)因发现有活动性出血而行开胸手术,1例(5.9%)行该疗法后肺复张不明显而改行胸膜纤维板剥脱术。该组病人平均住院天数为(8.5±3.63)d(3￣15d),与单纯应用尿激酶胸腔内注射治疗凝固性血胸疗法相比(16.9±8.05)d,差别有统计学意义(P<0.01),尿激酶平均用量为25±7.5(5￣40)万IU,与单纯应用尿激酶胸腔内注射治疗凝固性血胸疗法相比,差别有统计学意义(P<0.05)。与开胸手术或胸腔镜手术相比,该疗法具有创伤小、住院天数短的优点。本疗法应用前后凝血酶原时间、部分活化凝血活酶时间、血小板数量无明显变化,而且无并发症发生。结论该组病人治愈率88.2%,无并发症发生,说明该疗法可应用于外伤性凝固血胸的治疗,并且方法简单、疗效确切安全,特别适合基层医院开展。

[Objective] To observe therapeutic effects of the treatment of traumatic clotted homothorax by combining fibre bronchoscope with intrapleural fibrinolytic UK and evaluate its safety. [Methods] 17 cases of traumatic clotted homothorax had been chosen to be treaded by this treatment among 3~15 days after trauma. The mean drainage, the success rate, the mean doses of urokinase, the mean hospital stay and blood coagulation function in all patients were observed and recorded .Compared with history documents, the merit and defect of this treatment was analysised. [Results] The difference of success rate between this study (88.2%) and history documents (91.07%) was no significance. In this study, the mean hospital stay for all patients was (8.5±3.63) (range, 3 to 15) days, and the mean doses of urokinase was (25±7.5) (5~40) 100 000 IU, compared with intrapleural fibrinolytic treatment ,the differences were significance. Compared with thoracotomy and VATS, this treatment was of less trauma and shorter hospital stay. The blood coagulation functions of all patients were no change after applyed this treatment.[Conclusion] The success rate of 88.2% and no complication of applying this treatment demonstrated that it could cure traumatic clotted homothorax and was safe.