胸外伤后急性呼吸衰竭的防治与病因分类

PREVENTION,TREATMENT AND PATHOGENIC CLASSIFICATION OF ACUTE RESPIRATORY FAILURE AFTER CHEST TRAUMA

本文分析了55例胸外伤后急性呼吸衰竭(ARF),发生率为13％(55/423)。伴有休克或(和)心电图异常31例,昏迷14例,肾功能障碍13例和肝功能障碍9例,死亡7例,死亡率12.7％。ARF随着合并功能障碍脏器数目的增多,死亡的危险性明显增加。在总结临床经验的基础上作者指出,及早预防和处理ARF和脏器功能障碍,是降低胸外伤死亡率的关键,并提出了按照主要病因和发病机理将胸外伤后ARF分为:(1)外呼吸障碍,(2)肺挫伤,(3)继发性病因所致三类呼衰的分类方法。第(3)类ARF的死亡率最高。

The clinical data of fifty five cases of acute respiratory failure (ARF) after chest trauma were analyzed in this paper.The incidence was 13% (55/423).It was associated with shock and/or abnormal ECG in 31 cases,coma in 14 cases,renal insufficiency in 13 cases,and liver insufficiency in 9 cases.Seven patients died,with a mortality rate of 12.7%.The more the organs involved in disfunction,the higher the mortality of ARF.On the basis of the clinical experience,it is the belief of the authors that the key to decrease the mortality rate of the chest trauma lies in the prevention and treatment of ARF,as well as internal organ disorders as soon as possible.The authors suggest that,according to the pathogenic mechanism.ARF after chest trauma may be classified into three types:(1) ARF due to injury of the thorace cage.(2)ARF subsequant to pulmonary contusion,and (3) ARF due to secondary pathogenic causes.The third type of ARF is usually associated with the highest mortafi-ty rate.