开放性胸部损伤36例临床分析

目的报告36例开放性胸部损伤的外科治疗方法,总结其临床经验。方法本组36例,在确诊为开放性胸部损伤后采用即刻全麻下剖胸探查,术中发现肋间血管及胸廓内动脉破裂者10例,予以缝扎止血;肺裂伤者14例（其中2例合并肋间血管破坏）,行肺裂伤修补13例,肺叶切除1例;单纯心包裂伤2例,心脏破裂5例,膈肌破裂及合并肝、脾、肾破裂7例,均行缝合修补术。结果本组34例经急诊剖胸手术治疗痊愈,2例因心脏破裂口较大,来时已有重度失血性休克,经抢救无效死亡。结论开放性胸部损伤往往是由锐器造成,极易导致心、肺等重要脏器和/或腹腔脏器损伤,病情变化快。早期行剖胸探查、控制出血、修补受损脏器是抢救患者的有效方法。

Clinical analysis of 36 cases of open chest trauma

Objective To report surgical methods in the treatment of 36 cases of open chest trauma and summarize the clinical experience. Methods Thirty six cases of open chest trauma were analyzed. All the cases underwent immediate exploratory thoracotomy under general anesthesia. Ten of them with intercostal blood vessels and internal thoracic arteries broken were treated by sewing and ligation. Fourteen cases had injured lungs （ two of them combined with broken intercostals blood vessels） , among whom 13 underwent lung laceration repair and one underwent lobe excision. The remaining included 2 cases of pericardium laceration, 5 cases of cardiac rupture, 7 cases of diaphragm rupture combined with rupture of liver, spleen or kidney, all of whom were treated with suture and neoplasty. Results Of the 36 cases explored, 34 recovered after emergency thoracotomy and 2 died from large cardiac rupture and severe hemorrhagic shock despite the emergency measures. Conclusion The open chest trauma is usually caused by sharp instrument and often concerned with the injury of important organs such as the heart and lung and other abdominal viscera. It is characteristic of fast progress of the patient＇s conditions. The effective measures are recommended as early exploratory thoracotomy, hemorrhage controlling and repair of injured organs and viscera.