Romanoff H
Ann Surg. 1975 Aug;182(2):144-9. doi: 10.1097/00000658-197508000-00011.
Infection is a major complication of military chest injuries. In a series of 142 wounded, infectious complications occurred in 7 (4.9%). Factors influencing the incidence of infection are evaluated. In this group of injuries, 81 patients were admitted soon after wounding. The intrathoracic damage was severe, due to penetration of metallic fragment. The hemothorax was treated by immediate intercostal drainage. Immediate thoracotomy was performed in 10 patients and late thoractomy in 15. One patient developed a lung abscess and 5 patients had infection following thoracotomy (7.4%). Another 61 wounded patients had been first managed in a forward hospital, including three with thoractomy for massive bleeding. Two, not in a forward hospital, had a bullet removed from the lung. Upon admission to this hospital, intercostal drains were inserted when needed and four patients underwent thoracotomy. Larger wounds were debrided in 24 patients. Late thoracotomy was perfromed in seven. Chronic empyema developed in one patient after pneumonectomy performed at the field hospital, resulting in a resuscitation or infection rate of less than 2%. Factors contributing to a low infection rate were: early drainage of hemothoraces and wide debridement of larger wounds with delayed closure and avoidance of thoracotomy as primary treatment. Resection of lung tissue was avoided. Thoraco-abdominal injuries were treated separately. The clotted hemothorax was immediately evacuated. Prolonged antibiotic therapy was usually indicated.
感染是胸部战伤的主要并发症。在142例伤员中，有7例（4.9%）发生了感染并发症。对影响感染发生率的因素进行了评估。在这组伤员中，81例在受伤后不久入院。由于金属碎片穿透，胸内损伤严重。血胸通过立即行肋间引流进行治疗。10例患者立即行开胸手术，15例患者延迟开胸手术。1例患者发生肺脓肿，5例患者开胸手术后发生感染（7.4%）。另外61例伤员最初在前方医院接受治疗，其中3例因大出血行开胸手术。2例不在前方医院的患者肺部取出子弹。入院后，根据需要插入肋间引流管，4例患者接受了开胸手术。24例患者对较大伤口进行了清创。7例患者进行了延迟开胸手术。1例患者在野战医院行肺切除术后发生慢性脓胸，复苏或感染率低于2%。感染率低的因素包括：血胸早期引流、较大伤口广泛清创并延迟缝合、避免将开胸手术作为主要治疗方法、避免切除肺组织、分别处理胸腹联合伤、立即清除凝固性血胸、通常需要延长抗生素治疗时间。
