胸部穿透伤救治中常见失误及预防

目的 探讨和指出胸部穿透伤救治中的失误、难点，危险因素，并发症及防范措施。方法 回顾总结的胸部穿透伤３１８例，重点分析诊治错误和并发症。结果 胸腔伤的物理和Ｘ线漏误诊率为１１．１％（３５／３１６），但致使误治率仅为４．１％（１３／３１６），２４例心脏大血管损伤初期漏误诊５例。２８例膈肌损伤早期漏诊９例。２６７例次有腔闭式引流操作失误１１例次（４．１％）。发生需剖胸处理的并发症１７例。全组治愈３０８

Errors and prevention in management of penetrating chest injuries

Objective To identify the key points and the prevention of iatrogenic complications in the management of penetrating chest injuries. Methods Retrospective study was conducted on 318 patients with penetrating chest injury with the emphasis on errors in diagnosis and treatments and iatrogenic complications. Results Mis- or missed diagnosis accounted for 11.1% (35/316) of penetrating pleural injuries on initial physical and radiological examination, but only 4.1% (13/316) led to a final misdiagnosis. Among 24 patients with cardiac and vascular injuries, 5 were missed or delayed diagnosis, and it was 9 in 28 diaphragmatic injuried patients. Incorrect closed thoracic drainage occurred in 11 cases (4.1%). In this series, 17 patients had to undergo thoracic surgical procedures for the complications. Conclusions The present study identifies five factors prone to mis- or missed diagnosis in the management of penetrating chest injuries: (1) gunshot wounds combining lung contusion, (2)delayed hemothorax or/and pneumothorax, (3)cardiac wounds with stable hemodynamics and without tamponade signs, (4)diaphragmatic injuries with slight or non-abdominal sings, (5)careless manipulation for closed thoracic drainage.