Hunt P A, Greaves I, Owens W A
Department of Academic Emergency Medicine, James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, UK.
Injury. 2006 Jan;37(1):1-19. doi: 10.1016/j.injury.2005.02.014. Epub 2005 Apr 20.
Thoracic trauma is one of the leading causes of death in all age groups and accounts for 25-50% of all traumatic injuries. While the majority of patients with thoracic trauma can be managed conservatively, a small but significant number requires emergency thoracotomy as part of their initial resuscitation. The procedure has been advocated for evacuation of pericardial tamponade, direct control of intrathoracic haemorrhage, control of massive air-embolism, open cardiac massage and cross-clamping of the descending aorta. Emergency thoracotomy can be defined as thoracotomy "occurring either immediately at the site of injury, or in the emergency department or operating room as an integral part of the initial resuscitation process". Following emergency thoracotomy, the overall survival rates for penetrating thoracic trauma are around 9-12% but have been reported to be as high as 38%. The survival rate for blunt trauma is approximately 1-2%. The decision to perform emergency thoracotomy involves careful evaluation of the scientific, ethical, social and economic issues. This article aims to provide a review of the current literature and to outline the pathophysiological features, technical manoeuvres and selective indications for emergency thoracotomy as a component of the initial resuscitation of trauma victims with thoracic injury.
胸部创伤是所有年龄组死亡的主要原因之一，占所有创伤性损伤的25% - 50%。虽然大多数胸部创伤患者可以采用保守治疗，但仍有一小部分但数量可观的患者需要紧急开胸手术作为初始复苏的一部分。该手术已被提倡用于心包填塞的引流、胸腔内出血的直接控制、大量空气栓塞的控制、开胸心脏按压以及降主动脉的交叉钳夹。紧急开胸手术可定义为“在受伤现场立即进行，或在急诊科或手术室作为初始复苏过程的一个组成部分进行”的开胸手术。紧急开胸手术后，穿透性胸部创伤的总体生存率约为9% - 12%，但据报道高达38%。钝性创伤的生存率约为1% - 2%。决定进行紧急开胸手术需要仔细评估科学、伦理、社会和经济问题。本文旨在对当前文献进行综述，并概述紧急开胸手术作为胸部受伤创伤受害者初始复苏一部分的病理生理特征、技术操作和选择性适应症。
