颈部创伤的急救治疗探讨

Study on emergency treatment of neck trauma

目的探讨颈部创伤紧急救治的临床经验与注意事项。方法回顾性分析2006年1月至2008年2月收治的37例严重颈部复合伤患者的临床资料,其中10例颈部异物伤的患者经缝合、修补、结扎重要器官,剔除失活组织,拔除异物等治疗;8例闭合性喉气管外伤的患者,2例行保守治疗,5例行气管切开、环杓关节拨动术治疗,1例行甲状软骨、环状软骨复位术置入喉扩张管的治疗;19例开放性喉气管外伤的患者,15例气管切开但未置喉扩张管的治疗,4例置喉扩张管的治疗。结果32例痊愈出院,4例呼吸通畅,但发音质量稍差,1例因脓胸感染性休克死亡。结论保持呼吸道通畅、止血、抗休克是急救的关键,早期正确处理颈部重要器官可避免喉气管狭窄和神经系统并发症的发生,同时注意食管、甲状腺、喉返神经等损伤的修复也至关重要。

Objective To explore the experience and notice items in emergency treatment of neck trauma. Methods The clinical data of 37 patients with severe compound neck trauma, 26 males and 11 females, were retrospectively analyzed. Of which 10 cases of neck trauma for foreign body were restored,ligated ,weeded losing livingness tissure and removed foreign body; Among 8 cases of closed injury in neck, 2 cases received conserveative treatment, 5 cases underwent emergent tracheotomy, 1 case underwent immediately reconstruction of the laryngotracheal function; Among 19 cases of open injury in neck, 15 cases underwent emergent tracheotomy without dilater, 4 cases underwent emergent tracheotomy with dilater. Results 32 cases in all cases best survived. 4 cases better breathed with bad voice. 1 case died of pyothorax and infection shock. Conclusion Keeping best respiration,hemostasia and resisting shock in patients with neck trauma is the successful rescue key of emergency treatment. Treating with importance apparatus of neck appropriately in the early stage can avoid appearance of laryngotracheal stenosis and neurological complications. It is essential also that oesophagus, thyroid gland and neck nerve are restored.