The Role of Regional Block and Sedation Accompanıed Thoracoscopy on the Diagnosis and Treatment of Post-Trauma Patients Chest Tube Inserted

Öz

Traumatic hemothorax/pneumothorax; is a pathological condition seen in blunt and sharp thoracic traumas and can generally be treated by tube thoracostomy. While patients are being followed up with tube thoracotomy, analgesics support, and respiratory exercise support; emergency thoracotomy is usually not required. Early thoracoscopy is a method that has come to the fore in recent years. This thoracoscopy is known to have therapeutic and diagnostic benefits. In our study; the files of 40 patients who underwent tube thoracostomy after traumatic hemothorax/pneumothorax were reviewed retrospectively. Twenty of these patients, whose radiological and clinical improvement could not be achieved after tube thoracostomy, underwent thoracoscopy with sedo-analgesia on the first day after the procedure. The remaining 20 patients were followed up without any additional procedures. Patients' age, gender, trauma type, tube thoracostomy indication, presence of additional trauma, length of chest tube stay, length of hospital stay, WBC, RDW, %Neu, pO2, pCO2, SO2, presence of tube malposition, and complications were recorded from patient files. Demographic data of the two groups were similar. While tube withdrawal time was 4.7±1.5 days in the thoracoscopy group, it was 6.9±1.9 days in the control group. This difference was statistically significant (p < 0.001). The mean hospital stay was 7.1±2.0 days in the first group, while it was 9.3±3.3 days in the control group. This difference was statistically significant (p=0.014). In both groups, there was a 1 (5%) patient who developed a need for thoracotomy. Thoracoscopy with sedo-analgesia in early period is a safe method for patients who have undergone tube thoracostomy due to trauma. This method reduces the duration of chest tube removal and hospital stay of patients. The need for thoracotomy after follow-up was similar in both groups..

Anahtar Kelimeler

• Hemothorax
• pneumothorax
• regional block
• sedation
• thoracic trauma
• tube thoracostomy

Travma Sonrası Göğüs Tüpü Uygulanan Hastalarda Rejyonel Blok ve Sedasyon Eşliğinde Torakoskopinin Tanı ve Tedavideki Yeri

Öz

Travmatik hemo/pnömotoraks künt ve keskin toraks travmalarında görülen ve genellikle tüp torakostomi uygulanarak tedavi edilebilen patolojik durumdur. Hastalar tüp torakostomi, analjezik ve solunum egzersizi desteği ile izlenirken acil torakotomi genellikle gerekmez. Erken dönem torakoskopi uygulanması son yıllarda gündeme gelen bir yöntemdir ve bu torakoskopinin tedavi edici ve tanısal faydaları olduğu bilinmektedir. Çalışmamızda travmatik hemo/pnömotoraks sonrası tüp torakostomi uygulanmış 40 hastanın dosyası retrospektif olarak incelenmiştir. Tüp torakostomi uygulanması sonrası radyolojik ve klinik iyileşmesi sağlanamamış bu hasta grubunun 20’sine işlem sonrası birinci günde sedo-analjezi eşliğinde torakoskopi uygulanmış, 20’sine ise ek işlem uygulanmadan takibine devam edilmiştir. Hastaların yaşı, cinsiyeti, travma tipi, tüp torakostomi endikasyonu, ek travmasının varlığı, göğüs tüpü kalış süresi, hastanede yatış süresi, WBC, RDW, %Neu, pO2, pCO2, SO2 değerleri, tüp malpozisyonu varlığı ve gelişen komplikasyonlar hasta dosyalarından kaydedilmiştir. Çalışmaya katılan iki grubun da demografik verileri benzerdi. Tüp çekilme süresi torakoskopi uygulanan grupta ortalama 4,7±1,5 gün iken, kontrol grubunda ise ortalama 6,9±1.9 gündü ve bu fark istatistiksel olarak anlamlıydı (p < 0,001). Torakoskopi uygulanan grubun hastanede yatış süresi ortalama 7,1±2,0 gün iken, kontrol grubunda ise ortalama 9,3±3,3 gündü ve bu fark istatistiksel olarak anlamlıydı (p=0,014). Her iki grupta da 1’er (%5) hastada torakotomi ihtiyacı gelişti. Travma nedeni ile tüp torakostomi uygulanmış hastalara erken dönem sedoanaljezi ile torakoskopi uygulanması güvenli bir yöntemdir ve hastaların göğüs tüpünün çekilme süreleri ile hastanede kalış sürelerini azalttığı görülmektedir. Takip sonrası torakotomi gereksinimi ise iki grupta da benzer bulunmuştur.

Anahtar Kelimeler

• Hemotoraks
• pnömotoraks
• rejyonel blok
• sedasyon
• toraks travması
• tüp torakostomi

Kaynakça

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