颈部外伤的抢救体会

The rescue experience of neck trauma

目的探讨颈部外伤的有效诊治方法。方法回顾性分析2012年1月~2015年12月救治的17例颈部外伤患者,对诊治过程及预后情况进行回顾性分析。17例颈部外伤者中颈部牛挑伤3例,刎颈2例,锐器砍伤6例,车祸挤压撞击伤5例,爆炸异物刺伤1例。开放性损伤15例,闭合性损伤2例。结果本组中抢救成功15例,死亡2例。抢救成功15患者中,14例创口I期愈合,1例患者创口因为切口感染换药后Ⅲ期愈合;1例气管切开合并双侧喉返神经损伤患者术后半年行支撑喉镜下杓状软骨切除术,城垛式气管成形术,并拔除气管套管,无咽瘘、气管食管瘘、喉狭窄等并发症发生;2例声嘶明显,电子喉镜检查提示左侧声带固定1例,术后半年随访,患者声嘶明显好转,进食呛咳改善;左侧声带膜部瘀血1例,出院后3个月随访,声嘶完全改善。抢救成功15例患者术后均无偏瘫、失语、视力下降、复视等。结论迅速、准确的判断颈部外伤的严重程度,及时采取不同的急救措施,如颈部探查修复术、ICU抢救治疗等可有效挽回患者生命,减少并发症的发生。

Objective To investigate the effective methods for the diagnosis and treatment of neck trauma. Methods Clinical data of 17 patients with neck trauma treated in our hospital from Jan 2012 to Dec 2015 were analyzed retrospectively. Of the 17 cases, 3 were injured by cattle, 2 got suicide by cutting across their own necks, 6 were slashed by sharp instruments, 5 got impact and crush injury by traffic accidents, and one was stabbed by foreign body in explosion. In term of injury type, 15 cases were open injury and 2 closed injury. Results Of all the 17 cases, 15 were rescued successfully and 2 died. The wounds healed in stage I in 14, and one patient got infected but the wound healed in stage HI with dressing. One patient with tracheotomy for bilateral recurrent laryngeal nerve injury got decannulated in 6 months after laryngoscopic arytenoidectomy and battlement tracheoplasty without pharyngeal fistula, tracheoesophageal fistula, laryngeal stenosis and other complications. Of two cases with obvious hoarseness, one showed left vocal cord fixation under electronic laryngoscope examination and got significant relieves in hoarseness, dysphagia and cough after six months＇ follow-up, another case with blood stasis of left vocal cord was improved completely after three months. All the patients alive were cured without hemiplegia, aphasia, vision loss, diplopia and other permanent morbidities. Conclusion Accurate and rapid judgement of trauma severity, proper application of first-aid measures at early stage are critical to saving lives and reducing complications in neck trauma.