Slater R G
Department of Emergency Medicine, Natividad Medical Center, Salinas, California.
J Emerg Med. 1992 Jan-Feb;10(1):25-30. doi: 10.1016/0736-4679(92)90006-f.
Herniation of abdominal viscera into the thorax following traumatic diaphragmatic hernia can simulate acute tension pneumothorax. A case is presented of a blunt trauma victim with apparent acute diaphragmatic rupture, tension hemothorax, or tension hemopneumothorax. Nasogastric tube insertion demonstrated tension gastrothorax, but was followed by acute clinical decompensation. Percutaneous needle thoracostomy decompressed the stomach without causing spillage of gastric contents. Autopsy experimentation was performed to demonstrate that needle decompression of the distended stomach is well tolerated. Tension gastrothorax is a rare, life-threatening complication of traumatic diaphragmatic hernia. Although nasogastric tube placement should be attempted first, it may exacerbate the condition. Percutaneous needle decompression of the stomach through the chest wall can stabilize the situation and is safer and more rapid than chest tube placement, which might be either ineffective or dangerous. Paralyzing the patient with acute diaphragmatic rupture before tracheal and gastric intubation might prevent progression to tension gastrothorax.
创伤性膈疝后腹腔脏器疝入胸腔可类似急性张力性气胸。本文报告一例钝性创伤患者，表现为明显的急性膈破裂、张力性血胸或张力性血气胸。插入鼻胃管显示为张力性胃胸，但随后出现急性临床失代偿。经皮针胸腔造口术使胃减压，未导致胃内容物溢出。进行尸检实验以证明对扩张的胃进行针减压耐受性良好。张力性胃胸是创伤性膈疝的一种罕见且危及生命的并发症。虽然应首先尝试放置鼻胃管，但它可能会使病情加重。经胸壁对胃进行经皮针减压可稳定病情，且比放置胸管更安全、更迅速，放置胸管可能无效或危险。在气管插管和胃插管前对急性膈破裂患者进行麻痹可能会防止进展为张力性胃胸。
