闭合性肾损伤合并胸外伤79例临床诊治分析

Evaluation and treatment of closed renal trauma patients with thoracic trauma: analysis of 79 cases

目的探讨闭合性肾损伤合并胸外伤的致伤原因以及诊治特点。方法回顾性总结79例闭合性肾损伤合并胸外伤患者的临床诊断和抢救治疗措施。结果闭合性肾损伤合并胸外伤发生率较高,占同期闭合性肾损伤患者的39.9%(79/198)。且该类患者往往有相似的致伤原因。79例闭合性肾损伤合并胸外伤患者胸外伤的不同受伤方式与损伤类型的比较,差异有统计学意义(χ2=15.9488,P<0.05)。而CT对于胸外伤检出率分别与临床诊断比较(χ2=25.4432,P<0.01)、与X线比较(χ2=15.0176,P<0.01),差异均有极显著意义。79例中,闭合性肾损伤保守治疗75例,手术治疗4例;胸外伤中血气胸23例,行胸腔闭式引流术者12例。本组患者均有较好转归。结论闭合性肾损伤患者较常见合并胸外伤,绝大多数经CT检查可明确,需引起重视。早期发现和处理合并胸外伤,对于病情诊断、治疗抢救均有重要意义。

Objective To investigate the injury causes,diagnosis and treatment of closed renal trauma associated with thoracic trauma.Methods Retrospective study was carried in 79 closed renal trauma associated with thoracic trauma patients.Results Closed renal trauma patients associated with thoracic trauma,most of whom were similar in injury causes,were found a high incidence in all closed renal trauma patents（39.9%）.Significant difference was found in the incidence of various injury caused-thoracic trauma（χ2=15.9488,P0.05）.We found a significant higher diagnostic accuracy of patients with thoracic trauma when performed with CT scan as compared with clinical diagnosis（χ2=25.4432,P0.01） or X-ray（χ2=15.0176,P0.01）.Of these 79 patients,75 received expectant treatment,others were treated surgically.Twelve out of 23 patients with hemopneumothorax received closed drainage of thoracic cavity therapy.All patients had good prognosis.Conclusion Thoracic trauma may be common in closed renal trauma patients,most of these patients can be diagnosed through CT scan.The accurate diagnosis and treatment of thoracic trauma is very important.