(病名)血気胸

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/01 22:07:00」(JST)

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Hemopneumothorax, or haemopneumothorax, is a medical term describing the combination of two conditions: pneumothorax, or air in the chest cavity, and hemothorax (also called hæmothorax), or blood in the chest cavity.

A hemothorax, pneumothorax or both can occur if the chest wall is punctured. To understand the ramifications of this it is important to have an understanding of the role of the pleural space. The pleural space is located anatomically between the visceral membrane, which is firmly attached to the lungs, and the parietal membrane which is firmly attached to the chest wall (aka ribcage and intercostal muscles, muscles between the ribs). The pleural space contains pleural fluid. This fluid holds the two membranes together by surface tension, as much as a drop of water between two sheets of glass prevents them from separating. Because of this, when the intercostal muscles move the ribcage outward, the lungs are pulled out as well, dropping the pressure in the lungs and pulling air into the bronchi, when we 'breathe in'. The pleural space is maintained in a constant state of negative pressure (in comparison to atmospheric pressure).

If the chest wall, and thus the pleural space, is punctured, blood, air or both can enter the pleural space. Air/blood rushes into the space in order to equalise the pressure with that of the atmosphere. As a result the fluid is disrupted and the two membranes no longer adhere to each other. When the rib cage moves out, it no longer pulls the lungs with it. Thus the lungs cannot expand, the pressure in the lungs never drops and no air is pulled into the bronchi. Respiration is not possible. The affected lung, which has a great deal of elastic tissue, shrivels in what is referred to as a collapsed lung.

Treatment

Treatment for this condition is the same as for hemothorax and pneumothorax independently: by tube thoracostomy, the insertion of a chest drain through an incision made between the ribs, into the intercostal space. A chest tube must be inserted to drain blood and air from the pleural space so it can return to a state of negative pressure and function normally.

Commonly, surgery is needed to close off whatever injuries caused the blood and air to enter the cavity (e.g. stabbing, broken ribs).

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1. 成人における原発性自然気胸 primary spontaneous pneumothorax in adults
2. Placement and management of thoracostomy tubes
3. 小児における胸腔内損傷の概要 overview of intrathoracic injuries in children
4. 胸部超音波検査：適応、長所、および技術 thoracic ultrasound indications advantages and technique
5. 成人外傷患者における重症骨盤骨折 severe pelvic fracture in the adult trauma patient

English Journal

Recurrent catamenial hemopneumothorax treated by coverage with polyglycolic acid sheets.

Takahashi M, Matsukura T, Hirai T, Mino N.SourceDepartment of Chest Surgery, Fukui Red Cross Hospital, Fukui, Japan. Electronic address: mt10947@yahoo.co.jp.
The Journal of thoracic and cardiovascular surgery.J Thorac Cardiovasc Surg.2013 Jan;145(1):300-2. doi: 10.1016/j.jtcvs.2012.08.054. Epub 2012 Sep 13.
PMID 22982032

14 French pigtail catheters placed by surgeons to drain blood on trauma patients: Is 14-Fr too small?

Kulvatunyou N, Joseph B, Friese RS, Green D, Gries L, O'Keeffe T, Tang AL, Wynne JL, Rhee P.SourceFrom the Department of Surgery, Division of Trauma, University of Arizona, Tucson, Arizona.
The journal of trauma and acute care surgery.J Trauma Acute Care Surg.2012 Dec;73(6):1421-5. doi: 10.1097/TA.0b013e318271c1c7.
BACKGROUND: Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blo
PMID 23188235

Japanese Journal

症例胸部交感神経ブロック後に発症した血気胸の1例

境雄大,佐野淳,松倉聡 [他]
胸部外科 = The Japanese journal of thoracic surgery 67(7), 599-601, 2014-07
NAID 40020135057

特発性血気胸に対する可及的早期胸腔鏡下手術の検討

横須賀哲哉,小林利子
日本呼吸器外科学会雑誌 28(7), 838-841, 2014
我々はドレーン出血量によらず，特発性血気胸と診断または疑ったら可及的早期の胸腔鏡下手術（video assisted thoracic surgery：VATS）を行う方針としてきた．この方針で治療を行った13例を検討した．初診後5時間以内（2～5時間，平均2.5時間）にVATSを施行した．全例で胸腔最上部の断裂した索状物に出血源を同定し止血可能であった．術前のドレーン出血量は50～1850 ml …
NAID 130004705857

肋骨固定用プレートにより早期人工呼吸器離脱したフレイルチェストの１例

大島康史,飯塚亮二,市川哲也,岡田遥平,小田和正,榊原謙,石井亘,檜垣聡,日下部虎夫
日本外傷学会雑誌 28(4), 332-335, 2014
　症例は69歳，女性，自宅で転倒し，外傷性くも膜下出血，左鎖骨骨折，左外傷性血気胸，左第２〜10肋骨骨折を伴ったフレイルチェストを受傷した．左第３肋骨の遊離骨片が不安定で胸腔内に突出し，肺損傷の合併の可能性が高いため，外科的治療を施行した．術翌日に人工呼吸器から離脱し，治療期間中に肺炎の発症も認めなかった．　フレイルチェストに対する肋骨固定用プレートを用いた治療は開胸を必要とせず，手術器械による肺 …
NAID 130004699763