玉树地震救援中严重胸部外伤的早期治疗策略

目的探讨高原地震救援中严重胸部外伤的早期治疗策略。方法玉树地震期间共收治严重胸部外伤患者35例。根据早期损伤控制性原则进行胸腹壁外固定、止痛、限制输液速度和补液量、利尿以及抗休克等保守治疗。对血气胸出血量多者行胸腔穿刺放置闭式引流；对于创伤性湿肺患者同时给予大剂量激素冲击治疗等。结果本组病例治疗前血氧饱和度为（82．3＋4．1）％，心率为（96．4＋4．3）次／min，经短期治疗后血氧饱和度为（88．6＋3．8）％，心率（87．5＋4．8）次／min，治疗前后比较差异均有统计学意义（P〈0．05）。结论高原低氧条件下对严重胸部外伤早期进行损伤控制性治疗，如肋骨骨折简单外固定，合并血气胸、创伤性湿肺以及休克等重症患者给予穿刺置管胸腔闭式引流、限制输液速度和补液量、利尿和抗休克等综合治疗效果显著。

Early treatment to severe thoracic injury in Yushu earthquake rescue

Objective To evaluate the early treatment of severe thoracic injury in highland earthquake rescue. Methods 35 cases of severe thoracic injury were treated in Yushu earthquake rescue with conservative treatment based on the injury control principle, including chest wall simply fixing, pain relieving, speed and the amount of fluid infusion limiting, diuretic therapy, and shock controlling, and etc. Severe hemopneumothorax patients were treated with thoracentesis thoracic drainage; patients with traumatic wet lung were given high-dose steroid therapy. Results All the patients took a favorable turn after a short term treatment. The average saturation of blood oxygen reached to （88.6＋3.8） % from （82.3＋4.1） %. The average heart rate decreases to 87.5＋4.8 from 96.4＋4.3 per minute （P〈0.05）. Conclusion Simple fixation of rib fracture and combined therapy which include thoracic drainage, oxygen therapy, relieving pain and limiting fluid infusion, were effective treatment of severe thoracic injury in highland earthquake rescue.