85例胸外伤合并颅脑外伤患者的诊断治疗

为提高胸外伤合并颅脑外伤的早期诊断和治疗水平,回顾性分析85例胸外伤合并颅脑外伤患者的诊治资料.发现:致伤原因主要为交通事故伤.85例患者中,手术14例,死亡18例(21.2%):死于颅脑伤11例(61.1%),死于失血性休克3例(16.7%),死于成人型呼吸窘迫(ARDS)3例(16.7%),死于多系统和器官衰竭(MSOF)1例(5.5%).胸外伤合并颅脑外伤患者主要死因为颅脑伤,其次为失血性休克、ARDS及其他.结果提示:颅脑外伤的严重程度是影响病死率的主要因素.胸外科医生对颅脑合并伤应高度重视,力求早期诊断、及时处理,并应处理好休克与颅内高压的治疗矛盾.另外,胸脑合并伤致ARDS的发生率和病死率增加,也应引起重视.

Diagnosis and Treatment of Thoracic Injury Combined with Head Injury

The objective was to summarize the experience in the diagnosis and treatment of 85 cases of thoracic injury combined with head injury in order to improve the standard of diagnosis and treatment. We retrospectively reviewed 85 cases of thoracic injury combined with head injury. The main cause of thoracic injury combined with head injury was traffic accident(68 cases,80%). Operative treatments were employed in 14 cases. Eighteen cases(21.2%)died, of which 11 cases(61.1%)died of head injury, 3 cases(16.7%)of shock due to acute blood loss, 3 cases(16.7%)of ARDS, 1 case(5.5%)of MSOF. The results suggest that it's very important to realize the seriousness of head injury. The treatment should be performed with diagnosis at the same time. The injury history and physical examination are helpful to the diagnosis of head injury by injury history and physical examination. The dangerous and serious injury should take the priority of the treatment. It should be carefully dealt for the paradorical management between shock and intracranial hypertension. Attention should also be paid to the increase of the incidence and the mortality of ARDS in the thoracic injury combined with head injury.