胸部创伤1000例治疗

Treatment of 1000 Cases of Thoracic Trauma

本文报告了胸部创伤1000例。闭合性损伤683例;开放性损伤317例(31.7%);死亡63例,死亡率6.3%。作者根据实践认为:(1)在胸部创伤治疗中,应进一步强调闭式引流术的应用;(2)浮动胸治疗中纠正胸壁反常呼吸与治疗肺挫伤并重,不应偏废;(3)心脏损伤及时确诊并迅速解除心包填塞或控制心脏出血与修补是成败的关键,心包穿剌术仅作为辅助诊断与术前准备的一种临时措施;(4)气管与主支气管断裂伤,早期进行支气管吻合术,既达到最大限度的保留肺功能,又可减少并发症;(5)胸腹联合伤伴休克者,应在纠正休克的同时。优先处理致命性损伤,手术途径尽量避免胸腹联合切口。

The paper presents our experience in the treatment of 1000 cases of the thoracic trauma. Sixty-three cases in the series died of trauma with a mortality rate of 6. 3%. The authors emphasized:(1) The indications and advantages of intercostal tube drainage in the managment of severe thoracic injury. (2) Multiple rib fracture with frail chest is often associated with pulmonary contusion. Treatment should aim at the stabilization of thoracic wall and the treatment of pulmonary contusion. (3) Cardiac injuries can grouped into two main types, the hypovolemic shock type and cardiac tamponade type. Early diagnosis and immediate operation is often saving. (4) Rupture or tear of the trachea or bronchi requires early diagnosis and surgical repair. (5) Comdined thoracoabdominal trauma can be diagnosed based on both the chest and abdomen are injuried and associated with diaphragmatic rupture or perforation. Severe chset injury with intrathoracic bleeding or injury of Viscera demand early correction of hypovolemic shock and surgical exploration. Delayed diagnosis or misdiagnosis may lead to fatality. (Original article on page 152)