1045例胸部外伤患者临床分析与研究

目的了解胸部外伤的特点,探讨处理胸部外伤的策略.方法统计分析我院自1990年1月～2004年5月间收治的胸部外伤患者1045例,按院前时间、外伤疾病、临床表现、治疗方法、治疗结果分类.结果交通事故伤是胸部外伤最常见的原因(38.7%);闭合性胸部损伤占70%,经非手术治疗后好转、治愈者805例,占77%,须紧急开胸手术占胸外伤患者的5.5%,死亡率为0.7%,其中主要为合并心脏大血管损伤死亡和合并颅脑损伤死亡.结论加强交通安全教育是减少胸部创伤的重要环节.缩短院前时间、改善院前救护、加强基层医院对严重外伤的救治水平是降低死亡率的基础.多发伤的及时正确诊断、重视非手术治疗、及时手术治疗是降低死亡率的保障.     

严重腹部外伤118例诊治分析

目的探讨严重腹部外伤的诊治特点。方法对118例严重腹部外伤的临床资料进行回顾性分析。结果治愈111例，死亡7例，死亡率5．93％，二次腹部手术6例。结论及时、正确的诊断是救治的前提，提高早期诊断率、合理应用限制性液体复苏和损伤控制外科技术、积极治疗合并伤，是降低严重腹部外伤死亡率的关键。     

交通伤院前死亡的发生特点及护理对策

目的系统分析交通伤院前死亡的发生特点及其规律。探讨交通伤院前急救的护理对策。方法回顾性分析2001年至2004年交通伤院前救治4760例的临床资料。结果交通伤死亡810例中,院前死亡752例。占92．84％（其中现场死亡413例,占54．92％;运送途中死亡92例,占12．23％;急诊室死亡247例,占32．85％）;死亡的直接原因为重型颅脑损伤481例（63．96％）、严重多发伤113例（15．03％）。结论交通伤死亡病例主要发生在院前阶段,而现场死亡的比例最大,主要致死原因为重型颅脑损伤。可见,注重人员培训和现场救护技术,迅速到达现场,加强对重型颅脑损伤的早期救护,是降低交通伤死亡率的关键和重点。     

老年急性重型颅脑外伤的救治——附92例分析

本文总结了９２例老年性重型颅脑损伤，占同期老年颅脑外伤住院病例的２９．６８％，死亡３６例，死亡率３９．１３％。由于老年人脑萎缩及多器官退行性变，功能不佳，伤前又多患有慢性疾病，其发生颅脑外伤的类型、病理过程、临床表现、处理原则及预后均与儿童及青壮年有所不同。老年颅脑外伤早期临床表现不典型，易延误诊治，应严密观察。ＣＴ扫描可以确诊，必要时应随时复杂明确诊断，有手术指征者应及时清除颅内血肿解除脑受压。加强内科疗法，预防和治疗心脑血管疾病，改善脑血液循环等可以降低死亡率。合并伤、并发症也是影响预后的因素，应予以重视。     

62例严重胸部外伤的诊断和手术治疗

目的分析严重胸部外伤的临床诊断特点和手术的救治。方法对62例患者临床资料进行回顾性总结。钝性损伤32例(32／313，10．3％)，锐器性损伤30例(30／83，36．1％)。单纯胸部损伤37例，合并腹部伤12例，颅脑外伤2例，脊柱四肢及骨盆伤7例，3个部位以上多发伤4例。急诊手术59例，择期手术3例。结果术后治愈52例，1例右主支气管闭锁未愈，1例膈疝合并结肠破裂行膈肌修补 结肠造瘘4个月后二期手术，死亡8例。结论致伤因素不同引起的胸部伤情区别较大，临床应根据致伤的特点进行检查诊断，做出及时的手术救助措施。     

18例胸部外伤患者并糖尿病的围术期处理

目的探讨合并糖尿病的胸部外科手术患者的围手术期处理方法及术后治疗康复。方法对18例严重胸外伤合并糖尿病患者手术治疗前、中、后胰岛素的应用及预后并发症情况进行分析。结果18例胸部外伤术后,死亡1例,死亡率为5．6％。术后发生并发症6例,发生率为35．3％,感染3例占并发症的50％。结论胸部外伤围手术期胰岛素用量普遍较大,处理重点是有效地控制血糖,广谱抗生素预防感染,适当延长拆线时间,择期手术减少并发症的发生。     

老年人颅脑损伤58例临床分析

目的：探讨老年人颅脑损伤的特点及治疗。方法：分析60岁以上老年人颅脑损伤58例临床资料。结果：致伤原因多为车祸及跌伤，其中轻型占36％，中型占28％，重型占36％，合并颅内血肿25例。治愈65．5％，残存19％，死亡15．5％。结论：指出损伤范围，是否合并颅内血肿及脑疝等对预后有直接影响，严密观察、积极治疗、及时手术、处理合并伤及预防并发症是降低死亡率的有效措施。     

腹腔脏器损伤合并骨盆骨折的诊断与治疗

目的诠释腹腔脏器损伤合并骨盐骨折的诊断与救治措施。方法回顾分析17例腹腔脏器损伤合并骨盆骨折资料，腹腔脏器损伤的处理15例开腹手术，2例非手术治疗。骨盆骨折1例手术复位内固定，12例卧床休息，3例骨盆兜吊牵引，1例骨牵引。结果治愈15例，占88．24％，死亡2例，占11．76％。术后并发症3例，占17．64％，其中切口感染1例，粘连性肠梗阻1例，术后腹腔出血1例。结论腹腔脏器损伤合并骨盆骨折病情危重，强调早期诊断，及时合理选择治疗方法，则是提高抢救成功率，减少并发症和降低死亡率的关键。     

肝外伤治疗的选择与探讨

目的：探讨肝外伤治疗方法的选择。方法：回顾分析128例肝外伤的临床资料。结果：128例中单纯肝外伤85例（66.4%)，有合并伤43例（33．6％），诊断性腹腔穿刺110例，阳性101例（91．8％）。非手术治疗27例（21．1％），手术治疗101例（79．9％）。治愈108例（84．4％），死亡20例（15．6％）。结论：肝外伤非手术治疗中血流动力学监测尤为重要，同时B超监测亦有重要意义。手术治疗中没有一种固定的术式能解决不同类型肝外伤的问题，术式选择应根据损伤部位、范围、严重程度、有无合并伤等问题综合考虑。     

63例闭合性肾损伤并合并伤的诊治分析

目的总结闭合性肾损伤并合并伤的诊治体会，提高治疗效果。方法回顾分析63例闭合性肾损伤并合并伤的诊治资料。结果63例闭合性肾损伤并合并伤患者中，保守治疗20例，发生并发症2例；手术治疗43例，其中。肾切除20例，肾部分切除4例，肾修补术8例，探查引流术11例。死亡5例，死亡率7．9％。结论准确判断肾损伤的程度和合并伤的种类，严格掌握手术治疗和非手术治疗指征是处理肾损伤并合并伤的关键。     

重型颅脑损伤合并伤的救治策略与预后分析

目的探讨重型颅脑损伤合并伤的救治策略与预后的影响因素。方法对480例重型颅脑损伤合并伤的死亡率进行统计学单因素χ2分析和多因素Logistic回归分析。结果重型颅脑损伤合并颈椎损伤、胸部损伤、多发合并伤、休克明显增加其死亡率。结论合并颈椎损伤、胸部损伤、多发合并伤、休克是影响重型颅脑损伤预后的重要因素,仔细迅速的体检,必要的影像学检查,颈椎损伤及早颈部制动防止二次损伤,积极抗休克治疗,尽早手术控制胸腹腔内出血,合理的救治顺序是降低重型颅脑损伤合并伤患者死亡率的关键。     

一线三甲医院汶川地震107例多发伤合并胸伤的救治分析

目的总结汶川地震中多发伤合并胸伤的救治方法及效果。方法回顾性分析汶川地震后至2008年5月31日我院收治107例多发伤合并胸伤地震伤员的一般情况、救治情况及转归、死因等临床资料。结果多发伤急诊手术病死率前3位分别为肝修补、脾切除、颅内血肿清除减压;胸伤紧急处置病死率前3位分别为呼吸机支持、气管插管、胸腔闭式引流;多发伤分类病死率前3位分别为ARDS、胸骨骨折、连枷胸;死亡伤员均为AIS－90创伤严重度评分（ISS）评分很高的重度、极重度多发伤,颅脑伤、腹腔脏器伤和四肢骨盆伤是致死的主要因素之一,严重胸伤也是伤员致死的重要因素之一。结论汶川地震多发伤合并胸伤的救治中,严重创伤所导致的失血性休克和重型颅脑伤是伤员死亡的主要原因;胸伤的严重程度是死亡的重要因素之一。损伤部位越多、ISS评分越高、胸伤越重,病死率越高。迅速检查、快速诊断和分诊,尽早胸伤紧急处置,能为进一步抢救创造机会,提高抢救成功率。     

致伤因素对伤亡程度影响的回顾性对比分析

目的探讨交通工具与其他致伤因素对院前急救伤员伤亡程度影响的差异性。方法我院2009年1月1日至2010年12月31日实施院前创伤急救2657例伤员,按创伤严重程度评分法(ISS)标准评定记录伤情,根据致伤因素将院前急救伤员分为交通事故伤员组和其他外伤伤员组,分析两组伤员创伤程度和死亡人数的差异性,观察两类致伤因素对伤择伤亡程度的影响。结果交通事故伤员组创伤严重程度与其他外伤伤员组比较,差异均有显著统计学意义(P<0.01);两组伤员的创伤严重程度与受伤原因有相关性(χ2=93.2,P<0.01)。结论交通工具对伤员的损伤程度明显重于其他外力对伤员的损伤,应采取有效措施降低两类致伤因素对人类的危害。     

胸腹联合伤52例临床分析

目的:总结胸腹联合伤的诊断与治疗特点。方法:回顾1992年至2007年本院及达州市中心医院收治52例胸腹联合伤的临床资料,对其发病原因、部位、合并伤、诊断经过及手术途径等分别进行分析。结果:本组病例车祸伤36例,刀刺伤6例,击打伤4例,坠落伤6例。52例均行手术治疗,其中经左胸切口24例,经右胸切口9例,双侧剖胸4例,剖腹并剖胸术5例,经胸腹联合切口2例,经腹部切口8例。治愈48例,死亡4例,病死率为8%。结论:胸腹联合伤是一种特殊类型的损伤,伤情复杂、严重,死亡率高。临床处理中要注意避免漏诊膈肌损伤。早期及时处理是抢救成功的关键。     

腹部闭合性损伤合并颅脑损伤的治疗34例报道

目的探讨腹部闭合性损伤合并颅脑损伤的诊治方法。方法对34例腹部闭合性损伤合并颅脑损伤患者的临床资料进行回顾性分析。结果34例均经剖腹探查术,其中15例同时施行颅脑手术。住院期间死亡4例。结论腹部闭合性损伤合并颅脑损伤的处理,早期应明确伤情,处理好休克与颅内高压治疗的矛盾。早期诊断,及时手术,是减少并发症、降低死亡率的关键。     

Review of branch aortic injuries in blunt chest trauma

Objectives: To review the incidence, mechanisms of injury, diagnosis and treatment of injuries to the major branches of the thoracic aorta within the thoracic cavity following blunt trauma. Methods: Medline, Embase and Cochrane were searched using appropriate key word and MeSH headings. Full text articles were retrieved where there was any information relating to the mechanism of injury, incidence of injury, diagnosis, treatment or outcome in patients with injuries to the brachiocephalic, subclavian or carotid arteries within the thoracic cavity following blunt chest trauma. Results: The reported incidence of these injuries varied widely, most injuries were related to rapid deceleration injuries or falls. Diagnosis depends on a high level of clinic suspicion and appropriate investigations include helical CT scanning and arteriography. Treatment options have expanded in recent years with the use of endovascular stents; however, the optimal treatment remains uncertain. Conclusions: Aortic branch injuries must be actively excluded in patients with suspicious mechanisms of injury. Guidelines determining appropriate investigative pathways and methods of treatment should be developed at all trauma centres.     

Mortality in patients with loss of consciousness at the scene of trauma

Background and aim:

The aim of this study was to evaluate if loss of consciousness at the scene of an accident in patients with thoracic trauma classified by the Abbreviated Injury Scale (AIS) as thorax >2 has a different outcome in respect to immediate hospital discharge, hospitalization, death and type of accident.

Methods:

A prospective study was performed in the Regional Trauma Center of São José do Rio Preto. All patients with scores related to thoracic injury ≥2 were included in this study. Thus, 134 patients with penetrating and 231 with blunt thoracic injuries were evaluated. The chi-square, Fisher's exact and relative risk tests were utilized for statistical analysis with an alpha error greater than 5% (p?Results: A significantly higher number of patients who lost consciousness (35–33.9%) died compared to those who did not lose consciousness (9–3.5%, Fisher's exact test: p?Conclusion: The loss of consciousness at the time of trauma is a warning sign in patients with thoracic injuries whether associated with other types of injuries or not.     

Ocular trauma in Turkey: A 2-year prospective study

This 2-year prospective study was conducted to identify those at risk for ophthalmologic emergencies, to define the risk factors and reasons for eye injuries, to analyze treatment options, and to compare findings with those of previous studies. A total of 203 patients (74% male, mean age 27.3±13.9 y, 51% right eye injuries, 44% left eye injuries, 5% bilateral injuries) with injury to 208 eyes who presented to the emergency department for treatment were included in this study. All patients were evaluated by an ophthalmologist, who completed a formal questionnaire. Information recorded included demographic data, details of the eye injury, whether eye protection was used, and the type, location, and mechanism of injury to the eye. Mechanism of injury was categorized as blunt, sharp, or a combination. The ophthalmologist reported the time that had passed between occurrence of injury and presentation for treatment. Each patient was examined by the ophthalmologist, and findings, diagnosis, and treatment were documented. Of treated patients, 93% were hospitalized, most of whom required surgical treatment. One hundred (48%) injuries were related to blunt trauma and 86 (41%) to sharp device trauma. Only 10 (4%) patients were wearing protective eyewear when injured. Ruptured globe was the most common diagnosis of hospitalized patients and the most frequent cause of this was corneal lesions; subconjunctival hemorrhage was the most common diagnosis among nonhospitalized patients. In this study, the leading cause of eye injury was workplace accidents, probably attributable to growing industrialization in the region. Ocular trauma continues to be an important health problem in Turkey. Investigators believe that with education about and use of proper eye protection, 90% of eye injuries could be prevented.     

Major vascular injuries of the torso.

We reviewed autopsy data from 802 trauma deaths in northwestern Louisiana from January 1983 to March 1988 and found that 18% of all such deaths involved noncardiac major vascular injuries of the torso. Ninety-four percent of all deaths from blunt trauma and 45% of all deaths from penetrating trauma involved injury to the aorta, either thoracic or abdominal. Injuries to the thoracic aorta accounted for 11% of all trauma-related deaths in northwestern Louisiana; 68% of all victims died at the scene of the trauma. During this period 57 patients with noncardiac major vascular injuries of the torso were treated at the LSU-Shreveport Medical Center. Fifteen (26%) of these patients were transported to LSU-SMC from neighboring rural parishes outside the Shreveport-Bossier City metropolitan area. The mortality was 37%, and there was no difference in survival between those patients transported to LSU-SMC from within the Shreveport-Bossier City area and those transported from the rural parishes. Multivariate analysis of data showed that survival was determined by the complexity of the injury, the patient's ability to reach the hospital, and the stability of the patient's condition on arrival at the hospital. Transport time did not appear to affect survival.