Alexander J Q, Gutierrez C J, Mariano M C, Vander Laan T, Gaspard D J, Carpenter C L, Stain S C
Department of Medical Education, Huntington Memorial Hospital, Pasadena, California, USA.
Am Surg. 2000 Sep;66(9):855-7.
Blunt trauma patients with rib fractures have significant risk of morbidity and mortality. The risk of complications increases with age and cardiopulmonary disease. We reviewed our experience at a community hospital Level II trauma center over a 5-year period. A review of the trauma registry revealed 62 patients over the age of 65 with multiple rib fractures and no associated injuries. Thirty-one patients with cardiopulmonary disease (CPD+) were compared with 31 patients without cardiopulmonary disease (CPD-). Charts were reviewed for morbidity, mortality, the need to upgrade level of care (readmission to the hospital or intensive care unit), and length of hospitalization. Complications occurred in 17 of 31 CPD+ patients and in four of 31 CPD- patients (P < 0.001). The only three deaths were in CPD+ patients. Ten CPD+ patients and four CPD- patients required an upgrade in the level of care (P < 0.05). The CPD+ patients had longer hospitalization than the CPD- patients: 8.5 versus 4.3 days (P < 0.05). We conclude that elderly patients with multiple rib fractures and cardiopulmonary disease are at significant risk for complications that result in readmission to the hospital and intensive care unit and prolonged length of hospitalization. Admission to the intensive care unit with attention to cardiac and pulmonary status upon transfer to the ward is warranted.
肋骨骨折的钝性创伤患者有较高的发病和死亡风险。并发症的风险随着年龄和心肺疾病的增加而升高。我们回顾了我们在一家二级社区创伤中心5年期间的经验。对创伤登记册的审查显示，有62例65岁以上的患者有多根肋骨骨折且无相关损伤。将31例患有心肺疾病的患者（CPD+）与31例无心肺疾病的患者（CPD-）进行比较。查阅病历以了解发病率、死亡率、提高护理级别（再次入院或入住重症监护病房）的必要性以及住院时间。31例CPD+患者中有17例发生并发症，31例CPD-患者中有4例发生并发症（P<0.001）。仅有的3例死亡均为CPD+患者。10例CPD+患者和4例CPD-患者需要提高护理级别（P<0.05）。CPD+患者的住院时间比CPD-患者长：分别为8.5天和4.3天（P<0.05）。我们得出结论，患有多根肋骨骨折和心肺疾病的老年患者发生并发症的风险很高，这些并发症会导致再次入院和入住重症监护病房以及住院时间延长。有必要入住重症监护病房，并在转至病房时关注心脏和肺部状况。
