90年代胸伤发病特点和严重胸伤特殊问题处理

Epidemic Characteristics of Thoracic Trauma in 1990's & Clinical Treatment to Critic Chest Problems

目的分析90年代胸伤发病特点的变化，展望21世纪初胸伤救治战略和策略，总结现阶段对严重胸伤特殊问题的处理经验。方法回顾我科43年收治的胸伤1639例，分为1990年前后两组。比较两期例数、伤因、重伤构成比及住院死亡率，进行统计学检验。结果90年代胸伤增加、伤因谱变化（锐器伤、坠落伤和车祸伤增加），重伤增加（胸部刃器伤）和重症闭会伤、连枷胸、肺挫伤、急性呼吸窘迫综合征（ARDS）的比例明显高于1990年前组。救治死亡率从4.30％降至2.83％。伤后早期死因以失血性休克为主，晚期死亡原因多为ARDS与多器官功能不全综合征（MODS）。结论根据90年代胸伤因谱变化，应以胸部刀伤、车祸和高坠所致的闭合性多发伤为战略重点，以胸伤常见死因和特殊问题的处理为策略，提高救治质量，降低死亡率。作者对多发伤、休克、连枷胸与ARDS、支气管断裂、心脏损伤、老年脚伤、MODS等问题进行了讨论，并提出了伤因谱、胸伤和心脏伤分型、胸伤定量和疗效评价的建议。

Objective To analyze the epidemic characteristics of thoracic trauma in 1990's, to prospect the strategy and stratagem of measurements to thoracic trauma in the initial 21st century, and to summarize clinical experience in chest injury treatment. Methodes 1639 cases of chest injury victims between 1954 and 1996 were investigated retrospectively. They were grouped into two: the Pro -and post-1990 groups. Case numbers of per year, trauma causes, severe case ratio and hospital motalities of each group were compared. Results (1) Incidence and severity of chest injuries had been increasing since the recent decade. (2) Intrahospital mortality in our hospital had been decreasing from 4. 30% to 2. 83%. (3) Penetrating thoracic injuries caused by stab were increasing significantly, and so was the (4) sevre blunt thoracic trauma with flail chest and pulmonary contusion of ARDS. (5) The early hospital deaths were mainly caused by hemorrhage shock while the late deathsby ARDS and MODS. Conclusion It is suggested that major death causes be encircled for treatment according to the new characteristics and the treatment experiences of chest injury, so as to improve traumatic emergency and thoracic measurements for a futher decreasing of mortality in chest trauma. some special problems of chest trauma were discussed, such as classification to multiple injuries, hemorrhage shock, subclinical cardiac stab, bronchial rupture, flail chest and adult respiratory distress syudrome (ARDS), influences of chest trauma to accompanied traum, elderly chest trauma and multiple systems and organs failure(MODS).