地震群体伤中胸外伤的救治分析
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摘要
目的总结"5·12"地震中胸外伤患者的救治经验。方法分析2008年5月12～31日收治的合并胸外伤或以胸外伤为主的207例患者的临床资料,其中男113例,女94例,年龄(43.6±4.7)(11～80岁)。结果紧急气管插管25例,气管切开11例,呼吸机支持21例,胸腔闭式引流101例,加压包扎及胸带固定153例,伴有胸部以外脏器损伤者均得到相应救治。入院8h内死亡6例,8～72h死亡2例,均合并有颅脑、胸腹、骨盆等严重多发伤,无1例剖胸手术。结论对地震群体伤中胸外伤的救治,早期诊断应以物理检查和胸部X线、B超检查为主,早期治疗以保守和胸腔闭式引流为主,严格掌握开胸指征,重视多发伤的处理和急性呼吸窘迫综合征(ARDS)的诊治,注意延迟性血气胸和合并慢性阻塞性肺疾病(COPD)患者的治疗,防止院内交叉感染。
Objective To sum up the experience in diagnosis and treatment of thoracic injury in mass trauma after earthquake. Methods The clinical data of 207 patients with thoracic injury caused by the May 12 earthquake, 113 males and 94 females, aged (43.6±4.7) (11～80) , were analyzed. Results Emergent endotracheal intubation was performed in 25 cases, tracheotomy in 11 cases, mechanical ventilation in 21 cases, closed thoracic drainage in 101 cases, and local compressive bandaging and chest band fixation in 153 cases. Six patients died within the first 8 hours and 2 died within 8~72 hours after admission, all of which were suffering from accompanying serious multiple injuries of cranium, brain, chest, abdomen, pelvis, etc. No patient received thoracotomy. Conclusion Careful physical examination, X-ray examination, and B mode ultrasonography are the principal examination methods in the early diagnosis of thoracic injury. Treatment relies mainly on conservative therapy and closed thoracic drainage. The indication of thoracotomy must be taken into consideration carefully. Emphasis should be put on the management of multiple injuries and ARDS. Prevention of nosocomial cross infection is important.
Objective To sum up the experience in diagnosis and treatment of thoracic injury in mass trauma after earthquake. Methods The clinical data of 207 patients with thoracic injury caused by the May 12 earthquake, 113 males and 94 females, aged (43.6±4.7) (11～80) , were analyzed. Results Emergent endotracheal intubation was performed in 25 cases, tracheotomy in 11 cases, mechanical ventilation in 21 cases, closed thoracic drainage in 101 cases, and local compressive bandaging and chest band fixation in 153 cases. Six patients died within the first 8 hours and 2 died within 8~72 hours after admission, all of which were suffering from accompanying serious multiple injuries of cranium, brain, chest, abdomen, pelvis, etc. No patient received thoracotomy. Conclusion Careful physical examination, X-ray examination, and B mode ultrasonography are the principal examination methods in the early diagnosis of thoracic injury. Treatment relies mainly on conservative therapy and closed thoracic drainage. The indication of thoracotomy must be taken into consideration carefully. Emphasis should be put on the management of multiple injuries and ARDS. Prevention of nosocomial cross infection is important.
引文
[1]张连阳.胸部创伤救治现状.创伤外科杂志,2007,9(5);475-477.
[2]Wanek S,Mayberry JC.Blunt thoracic trauma:flail chest,pulmonary contusion,and blast injury.Crit Care Clin,2004,20(1):71-81.
[3]陈德昌.多发伤救治面临的挑战.中华创伤杂志,2004,20(1):4-6.
[4]李泽坚.我国胸外科的发展和展望.中华外科杂志,2006,14(2):937-939.
[5]杨帆,白祥军,唐朝晖,等.4519例多发伤院内救治分析.中国医学科学院学报,2007,29(4):471-477.
[6]Buduhan G,McRitchie DI.Missed injuries in patients with multiple trauma.J Trauma,2000,49(3):600-605.
[7]梁贵友,牛义民,刘达兴,等.连枷胸的机械通气治疗.中华创伤杂志,2005,21(7):531-534.
[8]刘汉,张铮,刘颍,等.有创通气治疗连枷胸合并肺挫伤的疗效.中华急诊医学杂志,2007,16(7):738-741.
[9]毛家模,罗芸葆.迟发性血胸35例诊治分析.创伤外科杂志,2003,5(5):381.
[2]Wanek S,Mayberry JC.Blunt thoracic trauma:flail chest,pulmonary contusion,and blast injury.Crit Care Clin,2004,20(1):71-81.
[3]陈德昌.多发伤救治面临的挑战.中华创伤杂志,2004,20(1):4-6.
[4]李泽坚.我国胸外科的发展和展望.中华外科杂志,2006,14(2):937-939.
[5]杨帆,白祥军,唐朝晖,等.4519例多发伤院内救治分析.中国医学科学院学报,2007,29(4):471-477.
[6]Buduhan G,McRitchie DI.Missed injuries in patients with multiple trauma.J Trauma,2000,49(3):600-605.
[7]梁贵友,牛义民,刘达兴,等.连枷胸的机械通气治疗.中华创伤杂志,2005,21(7):531-534.
[8]刘汉,张铮,刘颍,等.有创通气治疗连枷胸合并肺挫伤的疗效.中华急诊医学杂志,2007,16(7):738-741.
[9]毛家模,罗芸葆.迟发性血胸35例诊治分析.创伤外科杂志,2003,5(5):381.
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