肋骨骨折合并迟发性血胸31例临床分析

Analysis of 31 cases with ribs fracture combined with delayed hemothorax

回顾性分析我院2003年8月至2010年11月收治的31例迟发性血胸患者的临床资料。全组均有胸痛，有不同程度呼吸困难者14例（45％），心率增快19例（61％），发热16例（52％），七腹痛3例（10％），休克1例（3％）。血胸量均为中等以上，其中合并气胸9例。21例行胸腔闭式引流术，4例行胸腔穿刺抽液，5例行泼尼松口服保守治疗，1例合并膈疝者行开胸积血清除加膈肌修补术。全组均痊愈出院。肋骨骨折于胸部外伤48h～9d行x线胸片检查，密切观察患者胸部体征、呼吸、心率、体温等变化，是诊断和治疗迟发性血胸的关键。

The clinical data of 31 patients with delayed hemothorax between August 2003 to November 2010 was retrospectively analyzed. All patients had chest pain, difficult breathing in 14 cases （45%） , heart rate increased in 19 patients （61%）, fever in 16 cases （52%） , abdomen pain in 3 patients （10%）, and shock in 1 case （3%） . Haemothorax was medium to massive and combined with pneumothorax in 9 cases. Twenty one patients received closed chest drainage, 4 recieved chest puncture to eliminate fluid, 5 were treated conservatively, and 1 had surgery for diaphragmatic hernia and hemorrhage. All patients recovered eventually. The key of diagnosis and treatment for delayed hemothorax is to take chest X-ray for patients with rib fractures in 2 to 9 days after chest trauma, and carefully observing the changes of chest signs, breathing, heart rate and body temperature.