232 例胸部创伤的诊治经验

目的总结胸部创伤的诊治经验.方法回顾性分析1990年1月至1997年9月我院收治的232例胸部创伤病人.结果平均年龄33.9岁,男女比例5.4:1;致伤原因以车祸及刀刺伤为主,各占36.2%和24.6%.其中连枷胸20例,膈肌损伤9例,心脏刀刺伤4例,其它严重胸外伤37例.合并其它部位损伤84例,占36.2%.治愈221例(占有95.2%),死亡10例(占4.3%),出现各种并发症72例次.结论(1)疑有心脏锐器伤者,直接送入手术室有助于提高抢救成功率.(2)创伤性膈破裂者,X线及床旁B超检查有较高的阳性率.(3)肺挫伤者应重视急性呼吸窘迫综合症(ARDS)的预防.(4)连枷胸的治疗应在重视肺挫伤治疗的基础上,采取各种措施最大限度地减轻连枷胸的损害.

Diagnosis and teatment of thoracic trauma: report of 232 cases

Objective The aim of this article was to evaluate the diagnostic approach and management of chest trauma. Methods We retrospectively analyzed 232 cases of thoracic trauma admitted into our hospital between January 1990 and September 1997. Results The mean age of the patients was 33.9, and the male to female ratio was 5.4:1. The major causes of the injuries were traffic accident (36.2%) and stab wound (24.6%). There were flail chest in 20 patients, diaphragm injury in 9 patients, cardiac penetrating injury in 4 patients and other severe chest trauma in 37 patient. Eighty-four patients (36.2%) had concomitant other organ injuries. Altogether 221 patients (95.3%) were cured. The overall mortality was 4.3%(10/232). Complications of thoracic trauma were found in 72 cases. Conclusions (1) immediate operation for resuscitation for patients suspected of cardiac penetrating injury may improve survival rate. (2) Chest and abdominal rediographs or bedside ultrasonography has relatively high reliability in diagnosing dighragmatic rupture. (3) More attention should be paid to the diagnosis and timely treatment of acute respiratory distress syndrome (ARDS) in patients suffering from lung contusion. (4) Proper treatment of lung contusion should be emphasized in patients with flail chest and proper measures should be taken to minimize the damage.