341例交通事故胸外伤评分与评价

目的：研究胸伤为主的交通事故多发伤的临床特点和救治现状．方法：选择交通事故伤患者３４１例（５．７％），按来源、胸部伤情和结局分组评分，并预测生存概率Ｐｓ．结果：３４１例中，男２７３例，女６８例，０～８１（４１．８±１５．３）岁，胸闭合伤３４０例，伴多发伤２３４例，三个以上部位的９５例．各种并发症９２例次．存活组３０４例，死亡组３７例，两组年龄相同，死亡组院前时间较短，生理评分ＲＴＳ和ＧＣＳ较低，ＩＳＳ值和胸部ＡＩＳ值高于生存组；两组Ｐｓ有高度显著性差异．结论：胸伤和头伤受损伤程度对车祸患者死亡率的影响较大，可用以分型：胸伤为主型者，若呼吸加快则提示伴胸壁和胸膜腔损伤，或若有ＡＲＤＳ则提示大的肺挫伤或创伤性湿肺；胸伤为次型者，ＡＲＤＳ提示脑伤后神经源性肺水肿；脑伤为主且意识下降者，死亡较高．大型医院的胸部车祸患者伤势较重而死亡率较高，非预期死亡率较低．

Trauma Score and Evalutation in 341 Cases of Thoracic Injuries Due to Traffic Accidents

Aim: To evaluate the prognosis value of ASCOT (A Severity Characteristics of Trauma) for thoracic patients injured from traffic accidents. Methods: Three hundred and forty one patients from 2261 victims of traffic injuries were assessed with RTS, AIS ISS and ASCOT, and the prognostic survivals and deaths were compared with those of actual outcome. Results: The results showed that the ASCOT was satisfactory in the prognosis for survival patients, but not sensitive for died patients, e.g., there was a high incidence of mistaking died patients for survivals. The causes of such aberration might be (1) systemic errors of using foreign standard of trauma score to evaluate Chinese victims; (2) deficiency of trauma score system; (3)technical errors of performing trauma score assessment. Conclusion: We consider it necessary to establish Chinese database of trauma material in order to enact trauma score standard in China.