紧急剖胸术在胸部创伤救治中的应用

Application of emergency thoracotomy in treatment of chest trauma

目的探讨紧急剖胸术（ET）在胸部创伤救治中的应用指征和手术策略。方法回顾性分析2010年1月至2014年3月经ET救治的35例胸部创伤患者的临床资料。结果本组35例,损伤严重度评分（ISS）12~65分,平均31.63分。穿透伤23例,钝性伤12例。入院时休克28例（80.00%）。失血量1 000~5 000mL,平均2 400mL,其中22例失血量大于3 000mL。急诊室ET 6例,手术室ET 29例。入院至手术时间均小于30min。死亡12例（34.29%）,死亡组平均ISS评分48.26分,死亡原因主要为心脏压塞及失血性休克。存活23例（65.71%）,穿透伤和钝性伤存活率分别为78.26%（18/23）和41.67%（5/12）,存活者中并发症发生率为39.13%（9/23）。结论严重胸部创伤所致大出血、通气障碍和心脏压塞是ET的重要指征;胸部高危部位穿透伤应积极行剖胸探查;对于符合ET指征者,迅速剖胸是成功救治的关键。

Objective To discuss the application indications of emergency thoracotomy （ET） and the surgical strategy in the treatment of chest trauma .Methods The clinical data of 35 chest trauma patients treated by ET from January 2010 to March 2014 were analyzed retrospectively .Results In 35 cases ,the injury severity score （ISS） was 12-65 ,average 31 .63 .23 cases were pene‐trating injuries and 12 cases were blunt injuries .28 cases （80 .00% ） manifest as shock on admission .Blood loss in all cases was 1 000-5 000 mL ,average 2 400 mL and 20 cases were over 3 000 mL .ET was performed in the emergency room （6 cases） and the operative room （29 cases） .The time of admission to surgery in all cases was〈30 min .12 cases （34 .29% ） died ,with average ISS score of 48 .26 .The main causes of death were cardiac tamponade and hemorrhagic shock .23 cases （65 .71% ） survived .The surviv‐al rates of penetrating and blunt injury were 78 .26% （18/23） and 41 .67% （5/12） respectively .The occurrence rate of complications in the survivals was 39 .13% （9/23） .Conclusion Massive bleeding ,ventilation dysfunction and cardiac tamponade caused by severe chest trauma are the important indications of ET ;the patient with chest penetrating injury on high‐risk positions should be actively performed the exploratory thoracotomy ;race against time rapid thoracotomy is the key for successful treatment .