胸伤合并多发伤的临床特征与分型救治──10738例创伤住院患者回顾研究

Clinical features and classification of thoracic injuries with multiple trauma in 10738 patients

目的 分析近年胸伤的临床新特点 ,探讨严重胸伤的分型与救治方法。方法 收集各地 1993～ 1998年间重伤患者 10 73 8例临床资料 ,按照有无胸伤和多发伤 ,分为单纯胸伤、胸伤合并多发伤、多发伤胸伤为主等型 ,同期对照分析各型胸伤的不同特点 ;并对照前期胸伤患者资料 ,分析胸伤发病特点和临床特点的变化。 结果 ( 1)近年胸伤的年收治率净增 1.5倍 ;交通伤、锐钝器伤和高处坠落伤为胸伤主要伤因 ,而火器伤、锐钝器伤、挤压和高处坠落伤、交通伤等为胸伤高发原因 ;2 0～ 5 0岁男性为胸伤高发人群。 ( 2 ) 5 7.9% ( 995 1719)的胸伤达到损伤严重度评分 (ISS)≥ 16的重伤标准 ;血胸、肺挫伤、支气管断裂、急性呼吸窘迫综合征、心脏损伤、合并多发伤、多器官功能不全综合征等重伤患者明显增多。 ( 3 )近年 61.2 % ( 10 5 2 1719)的胸伤合并多发伤 ,伤情加重。 ( 4 )胸伤的非手术治疗开展较好 ,但手术治疗和院前救治需要加强。 结论 近年胸伤已成为一类重要的创伤 ,临床救治应加强开展胸伤的手术治疗和多发伤的多学科协作 。

Objective To analyze the new features of the thoracic injuries in recent years to explore the classification and the corresponding therapies. Methods The clinical data of 10 738 patients with severe injuries (their AIS ≥ 3 and the period during injury and hospitalization <24 hours) in 1993 1998 were collected from various places. The patients with thoracic injuries were divided into simple thoracic injury group, thoracic injury with multiple trauma group and thoracic leading multiple trauma group. In all the groups, the previous data of thoracic injury and the changes of clinical and epidemic features were analyzed. Results The hospitalization of thoracic trauma was doubled in recent years. The thoracic injuries were mainly caused by traffic accidents, sharp/blunt instruments and falls. Males aging 20 50 years were in high risk of thoracic injuries. About 57.9% of the patients suffered from severe thoracic injuries with ISS ≥ 16. Meanwhile, the patients with severe injuries suffering from hemopneumothorax, pulmonary contusion, bronchia rupture, acute respiratory distress syndrome, heart injury, multi organ thoracic injuries, systemic multiple trauma and multiple organ dysfunction syndrome increased significantly. About 61.2% of thoracic injuries were complicated by multiple trauma, which worsened the damage. Non surgical therapy for thoracic injury was developed better than the surgical and pre hospital treatments. Conclusions Thoracic injury has become an important kind of trauma. More cooperation should be made between the surgical treatment of thoracic injuries and the multiple trauma research. We also suggest making new criteria for the classification and the corresponding new operative methods for multiple trauma and heart injuries made by sharp instruments.