58例创伤性膈肌破裂的临床分析

Clinical assessment in 58 patients with traumatic rupture of diaphragm

目的:总结创伤性膈肌破裂的临床特点及诊治经验。方法:58例患者分为闭合伤组和穿透伤组,分析患者临床资料,并运用多种创伤评分法,进行损伤严重程度的评估。结果:闭合性膈肌破裂常并发全身多发伤,病情复杂,漏诊率(35.7%)及死亡率(21.4%)高;开放性损伤病情进展快,早期易出现失血性休克,但诊断较明确,预后好。比较两组的创伤评分,其中创伤严重度评分(ISS),改良创伤评分(RTS)及胸部简明创伤评分(AIS),两组间差异无统计学意义(P>0.05),但闭合伤组患者的格拉斯哥昏迷评分(GCS)和腹部简明创伤评分(AIS)较低(P<0.05)。结论:闭合性和开放性膈肌破裂在损伤机制、临床表现、诊断方法上存在明显的差异,临床上应针对损伤的不同类型,采取相应的诊断措施,提高救治率。而合理运用各种方法进行损伤严重度评分,有助于判断预后,评价救治水平。

Objective：To summarize the clinical characteristics,diagnosis and treatment in traumatic rupture of diaphragm. Method：Clinical data of 58 cases was analyzed,which was divided into blunt injury group and penetrated injury group. Severity was evaluated with trauma score. Result：Patients with blunt injury always combined with systemic injury. The complex situation resulted in more misdiagnosis（35.7%） and higher mortality（21.4%） . Though patients with penetrated injury usually accompanied with shock at early stage,they were easily to be diagnosed and had better prognosis. The GCS and abdominal AIS in blunt-injury group were significantly lower compared with the values in penetrated-injury patients（P0.05） . There were no differences in the ISS,RTS and thoracic AIS between these two groups（P0.05） . Conclusion：Since injured mechanism,clinical manifestation and diagnosis methods were obviously different in the two groups,different strategy should be applied to improve diagnosis and the prognosis. It is helpful to estimate treatment and prognosis by appropriately assessing the severity of trauma.