创伤性膈肌破裂的诊断与治疗

Diagnosis and treatment of traumatic diaphragmatic rupture

目的探讨创伤性膈肌破裂(TDR)的诊断与治疗方法,以提高其救治效果。方法对2000年1月至2012年1月武警后勤学院附属医院收治的47例TDR患者的临床资料进行分析,探讨其死亡相关危险因素及TDR院内诊断治疗方法,建立合理有效的急救流程。结果 47例TDR患者中,左侧29例(62.0%),右侧17例(36.0%),双侧1例(2.0%);交通事故是本组病例第1位发病原因;早期诊断(24 h内确诊)41例(87.2%),延迟诊断(超过24 h确诊)6例(12.8%);术前确诊32例(68.1%),术中确诊15例(31.9%);经腹切口修补4例(8.5%),经胸切口修补43例(91.5%);死亡7例(14.9%),存活40例(85.1%)。死亡组患者年龄与存活组比较差异无统计学意义(P>0.05);死亡组休克指数及创伤严重程度评分(ISS)均高于存活组,差异有统计学意义(P<0.05)。结论机动车交通事故是当前TDR的首要发病原因;TDR病死率与入院ISS评分及休克程度有一定关系。

Objective To explore the diagnosis and therapeutic methods of traumatic diaphragmatic rupture（ TDR） and improve the efficacy of treatment. Methods The data of 47 patients with TDR from January 2000 to January 2012 in the Affiliated Hospital of Logistics College of Chinese People＇s Armed Police were reviewed. Mortal factors in TDR were analyzed,the diagnosis and treatment were discussed,an efficient procedure for the TDR was made. Results Among the 47 cases,left side in 29 cases（ 62. 0%）,right side in 17 cases（ 36. 0%） and both side in 1 case（ 2. 0%）; traffic accident is the first aetiological agent of TDR in this group. Early diagnosis（ 24 h） was made in 41 cases（ 87. 2%） and delay diagnosis（ 24 h） and in 6 cases（ 12. 8%） was made; 32 cases（ 68. 1%） were confirmed before operation and 15 cases（ 31. 9%） were confirmed in operation; laparotomy in 4 cases（ 8. 5%）,thoracotomy in 43 cases（ 91. 5%）; death in 7 cases（ 14. 9%）,survival in 40 cases（ 85. 1%）. There was no statistical difference in age between dead group and survival group（ P 0. 05）; shock index and injury severity score（ ISS） of dead group were significantly higher than those in survival group and there were statistical differences（ P 0. 05）. Conclusion Traffic accident is the first aetiological agent of TDR. ISS and shock degree may have a correlation with mortality of TDR.