36例严重胸腹部多发伤的临床分析

目的　提高严重胸腹部多发伤的诊断和救治水平。方法　对 36例严重胸腹部多发伤进行回顾性总结分析。结果　临床体检和诊断性胸腹腔穿刺以及B超、X线、CT检查术前诊断率达 91 4 %。保守治疗 17例 ,其中胸腔闭式引流 16例 ,胸腔穿刺 1例。手术治疗 19例 ,其中闭合伤开胸探查 2例 ,闭合伤开腹探查 5例 ;开放伤开胸探查 2例 ,开放伤开腹探查 10例。治愈 31例 ,生存率 86 1% ,死亡 (包括病情加重自动出院在院外死亡 ) 5例 ,病死率 13 9%。结论　严重胸腹部多发伤应强调急救处理 ;体格检查、胸腹腔穿刺、B超、X线及CT对早期诊断有重要价值 ;争取时间及早手术、重视术后处理、防治并发症是提高救治水平的关键。

Clinical Analysis of 36 Cases of Severe Multiple Trauma of Thorax and Abdomen

Objective To improve the diagnosis and treatment of the severe multiple traumas of thorax and abdomen. Methods Retrospective analysis of 36 patients suffering from severe multiple trauma of thorax and abdomen. Results The rate of diagnosis before operation is 91.4% by physical examination, centesis, sonography, X-ray and CT. Conservative treatment was carried on 17 cases, including 1 case with pleural and celiac centesis, 17 cases with intubation of pleural cavity and sealing drainage. Operation was performed on 19 cases, including 2 cases with intra-pleural injury, 5 cases with intr-abdominal injury, 2 cases with open-pleural wound and 10 cases with open-abdominal wound. 31 cases are cured, survival rate is 86%. 5 cases are died, mortality rate is 13.9%. Conclusion First aids should be emphasized on severe multiple traumas of thorax and abdomen. Physical examination, centesis, sonography, X-ray and CT are valuable for early diagnosis. Operation in time, treatment after operation and prevention of complication are critical.