不同时期胸部创伤的特点及救治经验

目的比较不同时期收治胸部创伤（胸伤）的特点，围绕其院内死亡原因总结救治经验。方法将１６３９例胸伤分为１９９０年前、后两组，比较不同时期病例数、致伤原因、严重胸伤构成比及住院死亡率，并对伤后早期与晚期常见致死原因失血性休克、成人呼吸窘迫综合征（ＡＲＤＳ）和多系统器官衰竭（ＭＳＯＦ）等进行分析。结果９０年代后收治胸伤病例增多，穿透性刃器伤、重症钝性胸伤、连枷胸、肺挫伤和ＡＲＤＳ病例明显增加，住院死亡率从４．３０％降至２．９６％；住院早期死亡原因以失血性休克为主，晚期死亡原因多为ＡＲＤＳ和ＭＳＯＦ。结论应针对９０年代胸伤特点，围绕严重胸伤常见的致死原因，进一步改进急救和后续处理，降低死亡率。

Clinical Characteristics and Treatment Experiences of Chest Injuries in Different Periods

Objective To compare the clinical characteristics of chest injured patients hospitalized in the First University Hospital of WCUMS (West China University of Medical Sciences) in different periods to summarize the treatment experiences of chest trauma. Methods 1 639 cases of chest injury victims between the year 1954 and 1996 in this hospital were investigated retrospectively with the patients divided into two groups:Cases treated before 1990 and those after 1990.Number of cases per year,causes of injury,and the ratio of severe injured to total hospitalized injured were compared between two groups,and some common causes of death were analyzed,such as hemorrhagic shock,adult respiratory distress syndrome (ARDS) and multiple systems and organs failure (MSOF). Results (1)Incidence and severity of chest injuries have been increasing since the recent decade.(2) Hospital mortality in this hospital have been decreasing from 4.30% to 2.96%.(3)Penetrating thoracic injuries caused by sharp weapons are increasing significantly,and so is the severe blunt thoracic trauma with flail chest and pulmonary contusion or ARDS.(4) The early hospital deaths were mainly caused by hemorrhagic shock while the late deaths by ARDS and MSOF. Conclusion In view of the characteristics of chest injuries and common cause of death in recent decade,to improve the emergency management and surgical treatment is essential in further reduction of the mortality rate.