Chest:保留外伤性血胸的溶解疗法

2019-01-19 xiangting MedSci原创

溶解疗法可以减少保留外伤性血胸的外伤患者手术治疗的需要。需要随机对照试验来明确评估这种方法的益处。

胸腔内溶解疗法已成为许多胸膜疾病(包括血胸和脓胸)的重要治疗方式。保留外伤性血胸是一种常见并未被充分研究的胸膜疾病子集。目前保留外伤性血胸的治疗标准是手术治疗。在外伤人群中使用溶解疗法来避免手术干预尚未得到很好的证实。

在文献中查找报告使用胸腔内溶解疗法治疗保留外伤性血胸后手术干预的随机对照试验(RCT)和非RCTs。主要结局是使用任一种溶酶药治疗后不再需要手术。进行Meta分析以汇总这些研究的结果。还进行了溶解疗法类型的亚组分析和住院时间(LOS)分析。

分析汇总了1项RCT和9项非RCTs,共包括225名患者。87%的患者(95%CI:81%-92%)使用任一种溶酶药治疗后避免了手术。组织型纤溶酶原激活物(TPA)使得83%的患者避免了手术(95%CI:71%-94%),而其他非TPA溶酶药使得86%的患者避免了手术(95%CI:79%-94%)。接受溶解治疗患者的平均住院时间为14.88天(95%CI:12.88-16.88)。

溶解疗法可以减少保留外伤性血胸的外伤患者手术治疗的需要。需要随机对照试验来明确评估这种方法的益处。

原始出处:

Brandon S. Hendriksen. Lytic Therapy for Retained Traumatic Hemothorax: A Systematic Review and Meta-Analysis. Chest. 18 January 2019.

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