232例胸部创伤的诊治经验

Diagnosis and teatment of thoracic trauma: report of 232 cases

目的总结胸部创伤的诊治经验。方法回顾性分析１９９０年１月至１９９７年９月我院收治的２３２例胸部创伤病人。结果平均年龄３３.９岁，男女比例 ５４：１：致伤原因以车祸及刀刺伤为主，各占 ３６.２％和２４．６％。其中连枷胸２０例，膈肌损伤 ９例，心脏刀刺伤 ４例，其它严重胸外伤 ３７例。合并其它部位损伤 ８４例，占 ３６．２％。治愈 ２２１例（占有 ９５．２％），死亡 １０例（占 ４．３％），出现各种并发症 ７２例次。结论（１）疑有心脏锐器伤者，直接送入手术室有助于提高抢救成功率．（２）创伤性膈破裂者，Ｘ线及床旁Ｂ超检查有较高的阳性率。（３）肺挫伤者应重视急性呼吸窘迫综合症（ＡＲＤＳ）的预防。（４）连枷胸的治疗应在重视肺挫伤治疗的基础上，采取各种措施最大限度地减轻连枷胸的损害。

Objective The aim of this article was to evaluate the diagnostic approach and management of chest trauma. Methods We retrospectively analyzed 232 cases of thoracic trauma admitted into our hospital between January 1990 and September 1997. Results The mean age of the patients was 33.9, and the male to female ratio was 5.4:1. The major causes of the injuries were traffic accident (36.2%) and stab wound (24.6%). There were flail chest in 20 patients, diaphragm injury in 9 patients, cardiac penetrating injury in 4 patients and other severe chest trauma in 37 patient. Eighty-four patients (36.2%) had concomitant other organ injuries. Altogether 221 patients (95.3%) were cured. The overall mortality was 4.3%(10/232). Complications of thoracic trauma were found in 72 cases. Conclusions (1) immediate operation for resuscitation for patients suspected of cardiac penetrating injury may improve survival rate. (2) Chest and abdominal rediographs or bedside ultrasonography has relatively high reliability in diagnosing dighragmatic rupture. (3) More attention should be paid to the diagnosis and timely treatment of acute respiratory distress syndrome (ARDS) in patients suffering from lung contusion. (4) Proper treatment of lung contusion should be emphasized in patients with flail chest and proper measures should be taken to minimize the damage.