Résumé
Objective To evaluate the efficacy and risks of autologous blood patch pleurodesis in patients with persistent air leak(PAL)after lung resection. Methods A total of 97 patients with PAL after lung resection in Beijing Shijitan Hospital from October 2014 to October 2019 were retrospectively reviewed,including 53 treated by autologous blood patch pleurodesis and 44 by the conventional way.The therapeutic effect,adverse reactions and complications were analyzed. Results All the patients with PAL were cured with autologous blood patch pleurodesis.Most air leaks(81.1%)ceased within 48 hours after treatment,and the left 18.9% patients got cured after a repeat.The mean tube retention time and the mean in-hospital stay were 8.4 days and 10.0 days in the autologous blood patch pleurodesis group and 13.5 days and 15.3 days in the conventional treatment group.A prolonged drainage time(P=0.00)and in-hospital stay(P=0.00)were observed in the conventional treatment group.No severe complications were observed except two patients developed slight fever and cutaneous emphysema. Conclusion In our experience,the autologous blood patch pleurodesis is an effective way with low risk of adverse reactions in the treatment of PAL.
Sujets)
Humains , Drainage , Durée du séjour , Poumon , Pleurodèse , Études rétrospectivesRésumé
Persistent massive air leak after pediatric cardiac surgery is a rare and possibly life-threatening complication which is difficult to treat. We report a 3-month-old boy with hypoplastic left heart syndrome that underwent Glenn take-down, suffered from pulmonary hemorrhage during surgery and needed mechanical ventilation with high airway pressure that caused bilateral pneumothorax. After pulmonary hemorrhage improved, pneumothorax with persistent air leaks did not resolve under prolonged chest tubes. This patient underwent an autologous “blood patch” pleurodesis on postoperative day 32. The procedure was repeated a second time 48 h after the application of the first blood patch. After these procedures, air leaks dramatically ceased. The patient was successfully weaned from the ventilator on postoperative day 70. Pleurodesis with an autologous blood patch is a safe and an effective technique for the treatment of persistent air leaks, even for a 3-month-old boy with hypoplastic left heart syndrome.
Résumé
Se trata de una primigesta de 34 años de edad, quien presentó rotura prematura de membranas ovulares espontánea a las 24 semanas de gestación. Luego de realizar el diagnóstico clínico, microscópico y ecográfico de la entidad y descartando la presencia de infección, se decide la colocación de un parche hemático transvaginal endocervical autólogo como tratamiento de la presentó rotura prematura de membranas ovulares espontánea. La paciente evoluciona afebril con recuperación del líquido amniótico al sexto día del procedimiento. Inicia a las 35 semanas contracciones uterinas espontáneas dolorosas y al verificar en el monitoreo fetal intraparto un patrón compatible con desaceleración variable se decide la realización de una cesárea segmentaria obteniendo así un recién nacido pretérmino de 1550 g y 52 cm con evolución satisfactoria. El parche hemático transvaginal endocervical autólogo ofrece una alternativa como tratamiento de la presentó rotura prematura de membranas ovulares espontánea
This is the case of a 34-year-old primigravida who introduced spontaneous preterm premature rupture of membranes to 24 weeks of gestation. Then after clinical, microscopic, ultrasound diagnosis and discarding infection, we selected of a transvaginal endocervical autologous blood patch as the spontaneous preterm premature rupture of membranes treatment. The patient evolves without fever with the amniotic fluid recovery to the sixth day of the procedure. Start 35 weeks painful spontaneous uterine contractions and by verifying fetal monitoring intrapartum support Variable Deceleration Pattern is decided segment caesarean section giving a new born preterm 1550 g and 52 cm with satisfactory evolution. The transvaginal endocervical autologous blood patch offers an alternative to the spontaneous preterm premature rupture of membranes treatment
Sujets)
Grossesse , Administration par voie vaginale , Tests épicutanés/méthodes , Rupture prématurée des membranes foetales/diagnostic , Rupture prématurée des membranes foetales/thérapie , Autoantigènes/usage thérapeutiqueRésumé
Postdural puncture headache is the most common complication of unintentional dural puncture with an epidural needle. We present here the case of a 44-year-old woman who developed a severe headache from pneumocephalus, which was the result of an epidural blood patch procedure being performed to treat a PDPH. Both the epidural block and the autologous blood patch procedure were done at the L4-5 interspinous space with the loss of resistance technique and using air. After the epidural blood patch procedure, the headache was not relieved at the supine position and the computerized tomographic brain scan revealed the presence of air within the intracranial cavities. After conservative treatment, she was discharged from the hospital on the fourth-day without any neurologic sequelae.
Sujets)
Adulte , Femelle , Humains , Colmatage sanguin épidural , Encéphale , Céphalée , Aiguilles , Pneumocéphale , Céphalée post-ponction durale , Ponctions , Décubitus dorsalRésumé
Postdural puncture headache is the most common complication of unintentional dural puncture with an epidural needle. We present here the case of a 44-year-old woman who developed a severe headache from pneumocephalus, which was the result of an epidural blood patch procedure being performed to treat a PDPH. Both the epidural block and the autologous blood patch procedure were done at the L4-5 interspinous space with the loss of resistance technique and using air. After the epidural blood patch procedure, the headache was not relieved at the supine position and the computerized tomographic brain scan revealed the presence of air within the intracranial cavities. After conservative treatment, she was discharged from the hospital on the fourth-day without any neurologic sequelae.