损害控制在严重胸部创伤救治中的应用

目的探讨损害控制在严重胸部创伤救治中的应用。方法对我科2007年7月-2008年6月救治的62例严重胸部创伤（AIS≥3）病例资料进行回顾性分析。结果（1）全组死亡率为1．6％（1／62），手术组无死亡病例。（2）穿透伤单纯胸腔闭式引流术比例（55．6％，10／18）高于钝性伤（36．4％，16／44）（P=0．165）。穿透伤剖胸探查手术率为27．8％（5／18）高于钝性伤15．9％（7／44）（P=0．283）。连枷胸肋骨骨折内固定术占闭合性胸伤的11．4％（5／44）。（3）钝性伤并发症的发生率（63．6％，28／44）显著高于穿透伤（27．8％，5／18）（P=0．010）。老年患者更容易并发肺部并发症。结论初期尽快的确定性急救处理和简化手术修复是损害控制外科技术在严重胸部创伤救治中的基本策略。后期积极的生理复苏与并发症处理是提高严重胸伤救治成功率的关键。

Damage control surgery for patients with severe chest trauma

Objective To explore the effect of treatment of damage control surgery for patients with severe chest trauma. Methods A total of 62 patients with severe chest trauma （AIS≥3 ） from July 2007 to June 2008 were reviewed retrospectively. Results The mortality rate was 1.6% （ 1/62 ）. There were no dead cases in operation group. The ratio of close chest drainage for penetrating trauma（ 55.6% , 10/18）was higher than that for blunt trauma （36.4% ,16/44） （P = 0. 165） ,and the ratio of thoracotomy for penetrating injuries （27.8% ,5/18） was higher than that for blunt trauma（ 15.9% ,7/44） （P=0.283）. The internal fixation of rib fracture performed in patients with flail chest was 11.4% （ 5/44 ）. The incidence of complication of blunt trauma （ 63.6%, 28/44 ） was significantly higher than that of penetrating trauma （27.8% ,5/18） （P=0.010） ,and the lung complications were more common for the aged patients than younger group. Conclusion Early definitive care and abbreviated thoraeotomy at the initial operation are useful in the treatment of severe chest trauma. Active resuscitation in the intensive care unit and treatment of complications can raise the survival rate for patients with severe chest trauma.