紧急剖胸术救治胸部创伤34例

目的 探讨紧急剖胸术(emergency thoracotomy,ET)在严重胸部创伤中的应用价值.方法 回顾性分析本院34例ET的情况,男27例,女7例,年龄18～50岁(平均31.5 岁);钝性伤25例,穿透伤9例,分为急诊室ET(6例)和手术室ET(28例),记录一般资料、ISS、入院时生命体征、入院至手术的时间和结果.结果 34例ET, ISS 11～34分(平均25.8分).5例到达急诊室呼吸心跳已停止,入院至手术的平均时间为38min(15～78min),平均出血量2 300ml(1 100～5 000ml).钝性伤和穿透伤ET的存活率分别为72.00%(18/25)和77.78%(7/9).急诊室ET和手术室ET存活率分别为16.67%(1/6)、89.29%(25/28),包括18例钝性胸部伤(72.00%)和7例穿透性胸伤(77.78%).结论 急诊室ET对胸部钝性伤效果不佳,对穿透伤有一定价值;手术室ET不论对钝性伤或穿透伤均有较大意义.

Treatment of 34 cases thoracic trauma with emergency thoracotomy

Objective To analyze the application of emergency thoracotomy(ET) in patients with severe thoracic trauma.Methods Clinical data of 34 patients from Jan,2004 to Dec,2006 were analysed retrospectively.There were 27 males and 7 females with a mean age of 31.5 years.And there were 25 cases with blunt injury and 9 with penetrating injury.ET was divided into emergency room ET(6 cases) and operative room ET(28 cases).Data on demographics,injury severity score(ISS),signs of life on admission,time from admission to operation and outcome were also recorded and analyzed.Results In 34 cases,average ISS was 25.8(11-34).Respiration ceases and cardiac arrest were absent in 5 patients.The average time from admission to operation was 38 min(15-78min) and average hemorrhage was 2 300ml(1 100-5 000 ml).The survival ratio of ET performed in emergency department and in operating room was 16.67%(1/6) and 89.29%(25/28) respectively,include 18(72.00%)with penetrating injury and 7(77.78%)with blunt injury.Conclusion Emergency room ET has less use for blunt chest trauma,but was justifiable for penetrating chest injury.Operating room ET is justifiable for all thoracic trauma.