芦山地震所致胸部外伤17例临床分析
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摘要
目的总结"4·20"芦山地震胸部外伤的救治经验。方法回顾性分析华西医院胸外科2013年收治的芦山地震伤员17例的临床资料,其中男14例,女3例;年龄(57.3±16.1)岁。胸部外伤的诊断主要根据病史、体格检查、胸部X线片或胸部CT,分析其临床特点和治疗效果。结果重物砸伤12例(70.6%),摔伤4例(23.5%),车祸伤1例(5.9%)。胸部受伤情况包括皮肤软组织挫伤17例(100.0%),肋骨骨折15例(88.2%),1例伴有反常呼吸;肺挫伤15例(88.2%),血气胸11例(64.7%),胸骨骨折1例(5.9%),双侧气胸伴广泛皮下气肿1例(5.9%)。13例(76.5%)分别合并颅脑、腹部、骨折及神经损伤。1例因左侧凝固性血胸,左下肺不张行左侧凝固性血胸清除,肋骨内固定术。17例均得到及时、有效治疗,无死亡病例。结论地震伤由于致伤机制多样,伤员往往为多发伤。胸部损伤以肋骨骨折及肺挫伤为主。胸腔闭式引流术是一种简单有效的治疗手段,良好的镇痛及积极的纤维支气管镜治疗可帮助伤员有效清理呼吸道,保持呼吸道通畅。
Objective To summarize our treatment experience for patients with chest injuries in"4·20"Lushan earthquake.Methods Medical records of 17 patients with chest injuries after 2013 Lushan earthquake who were admitted to the Department of Thoracic Surgery,West China Hospital were analyzed retrospectively.The diagnosis of chest injuries was mainly confirmed by medical history,physical examination,X-ray and CT scan of the chest.Clinical characteristics and treatment outcomes were analyzed.Among the 17 patients,there were 14 men and 3 women with their age of 57.3±16.1 years.Results There were 12 patients(70.6%)with crash injury of heavy objects,4 patients(23.5%)with fall injury and 1 patient with road traffic injury.Chest injuries were skin and soft tissue contusion in 17 patients(100%),rib fracture in 15 patients(88.2%)including 1 patient with abnormal respiratory movements,pulmonary contusion in 15 patients(88.2%),hemopneumothorax in 11 patients(64.7%),sternal fracture in 1 patient(5.9%)and bilateral pneumothorax with widespread subcutaneous emphysema in 1 patient(5.9%).Thirteen patients(76.5%)had concomitant brain,abdominal,orthopedic or nerve injuries.One patient underwent left thoracotomy,clot removal and internal fixation of rib fractures for left coagulated hemothorax and left lower lobe atelectasis.All the 17 patients received timely and effective treatment and there was no in-hospital mortality.Conclusions Mechanisms of earthquake injuries are often complex,and patients often have multiple injuries.The main types of chest injury are rib fractures and pulmonary contusion.Tube thoracostomy is a simple and effective treatment strategy for them.Satisfactory pain management and bronchoscopy procedure can effectively help patients with removal of respiratory secretions and maintenance of airway patency.
Objective To summarize our treatment experience for patients with chest injuries in"4·20"Lushan earthquake.Methods Medical records of 17 patients with chest injuries after 2013 Lushan earthquake who were admitted to the Department of Thoracic Surgery,West China Hospital were analyzed retrospectively.The diagnosis of chest injuries was mainly confirmed by medical history,physical examination,X-ray and CT scan of the chest.Clinical characteristics and treatment outcomes were analyzed.Among the 17 patients,there were 14 men and 3 women with their age of 57.3±16.1 years.Results There were 12 patients(70.6%)with crash injury of heavy objects,4 patients(23.5%)with fall injury and 1 patient with road traffic injury.Chest injuries were skin and soft tissue contusion in 17 patients(100%),rib fracture in 15 patients(88.2%)including 1 patient with abnormal respiratory movements,pulmonary contusion in 15 patients(88.2%),hemopneumothorax in 11 patients(64.7%),sternal fracture in 1 patient(5.9%)and bilateral pneumothorax with widespread subcutaneous emphysema in 1 patient(5.9%).Thirteen patients(76.5%)had concomitant brain,abdominal,orthopedic or nerve injuries.One patient underwent left thoracotomy,clot removal and internal fixation of rib fractures for left coagulated hemothorax and left lower lobe atelectasis.All the 17 patients received timely and effective treatment and there was no in-hospital mortality.Conclusions Mechanisms of earthquake injuries are often complex,and patients often have multiple injuries.The main types of chest injury are rib fractures and pulmonary contusion.Tube thoracostomy is a simple and effective treatment strategy for them.Satisfactory pain management and bronchoscopy procedure can effectively help patients with removal of respiratory secretions and maintenance of airway patency.
引文
1 Hu Y,Tang Y,Yuan Y,et al.Trauma evaluation of patients with chest injury in the 2008 earthquake of Wenchuan,Sichuan,China.World J Surg,2010,34(4):728-732.
2 Hu J,Guo YQ,Zhang EY,et al.Chest injuries associated with earthquakes:an analysis of injuries sustained during the 2008 WenChuan earthquake in China.Surg Today,2010,40(8):729-733.
3 Sato K,Kobayashi M,Ishibashi S,et al.Chest injuries and the2011 Great East Japan Earthquake.Respiratory Investigation,2013,51 (1):24-27
4 谢晓冬,屈淑贤.地震所致外伤的类型和救治要点.辽宁医学杂志,2008,22(4):169-171.
5 刁明强,孙小康,彭志忠,等.地震群体伤中胸外伤的救治分析.中国急救复苏与灾害医学杂志,2008,3(1):645-652.
6 Toker A,Isitmangil T,Erdik O,et al.Analysis of chest injuries sustained during the 1999 Marmara earthquake.Surg Today,2002,32 (9):769-771.
7 刘伦旭,石应康.地震胸部损伤救治的几个问题.创伤外科杂志,2009,11(3):287-289.
8 郑轶峰,刘宝玉,姜建青,等.5.12汶川地震胸部外伤救治体会.四川医学,2009,30(9):1475-1476.
9 杨林江,高哲俊,刘刚,等.4 14玉树地震胸部外伤救治体会.高原医学杂志,2011,21(3):29-30.
10 Tanaka H,Yukioka T,Yamaguti Y,et al.Surgical stabilization of internal pneumatic stabilization?A prospective randomized study of management of severe flail chest patients.J Trauma,2002,52(4):727 -732.
11 薛欣盛,张中伟,周琰,等.汶川地震死亡相关因素分析.中国呼吸与危重监护杂志,2008,7(4):245-247.
2 Hu J,Guo YQ,Zhang EY,et al.Chest injuries associated with earthquakes:an analysis of injuries sustained during the 2008 WenChuan earthquake in China.Surg Today,2010,40(8):729-733.
3 Sato K,Kobayashi M,Ishibashi S,et al.Chest injuries and the2011 Great East Japan Earthquake.Respiratory Investigation,2013,51 (1):24-27
4 谢晓冬,屈淑贤.地震所致外伤的类型和救治要点.辽宁医学杂志,2008,22(4):169-171.
5 刁明强,孙小康,彭志忠,等.地震群体伤中胸外伤的救治分析.中国急救复苏与灾害医学杂志,2008,3(1):645-652.
6 Toker A,Isitmangil T,Erdik O,et al.Analysis of chest injuries sustained during the 1999 Marmara earthquake.Surg Today,2002,32 (9):769-771.
7 刘伦旭,石应康.地震胸部损伤救治的几个问题.创伤外科杂志,2009,11(3):287-289.
8 郑轶峰,刘宝玉,姜建青,等.5.12汶川地震胸部外伤救治体会.四川医学,2009,30(9):1475-1476.
9 杨林江,高哲俊,刘刚,等.4 14玉树地震胸部外伤救治体会.高原医学杂志,2011,21(3):29-30.
10 Tanaka H,Yukioka T,Yamaguti Y,et al.Surgical stabilization of internal pneumatic stabilization?A prospective randomized study of management of severe flail chest patients.J Trauma,2002,52(4):727 -732.
11 薛欣盛,张中伟,周琰,等.汶川地震死亡相关因素分析.中国呼吸与危重监护杂志,2008,7(4):245-247.
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