Dickenson C M
Crit Care Nurs Clin North Am. 1991 Sep;3(3):423-32.
Thoracic trauma is usually accompanied by other body system injury, most frequently head and skeletal injury. Developmental changes throughout childhood make the consequences of such injuries more severe, as children develop respiratory and circulatory compromise quickly. Blunt trauma predominates in pediatric thoracic trauma. Trauma to the thoracic cavity may involve fractures of the ribs or injuries where the ribs remain intact. Trauma involving the pleural space affects ventilation that may evolve into circulatory failure if not addressed promptly. Pulmonary contusion is among the most frequent and most fatal of thoracic injuries. Rupture of the tracheobronchial tree, esophagus, or diaphragm may have both short- and long-term consequences. Trauma to the heart and/or great vessels may be fatal at the scene of the accident, in the emergency department, or in the intensive care unit. Pain management is an essential part of caring for children with thoracic injury. A variety of methods have become available within the past several years that promote better pain relief and shorter recovery periods with less side effects. Nursing care of the child with PCA, epidural analgesia, or intercostal nerve blocks requires specific knowledge and assessment skills. Nonpharmacologic methods of pain relief may be used as an adjunct to pharmacologic methods.
胸部创伤通常伴有其他身体系统损伤，最常见的是头部和骨骼损伤。儿童期的发育变化使此类损伤的后果更为严重，因为儿童呼吸和循环功能受损发展迅速。钝性创伤在小儿胸部创伤中占主导地位。胸腔创伤可能涉及肋骨骨折或肋骨完整的损伤。涉及胸膜腔的创伤会影响通气，如果不及时处理，可能会发展为循环衰竭。肺挫伤是最常见且最致命的胸部损伤之一。气管支气管树、食管或膈肌破裂可能会产生短期和长期后果。心脏和/或大血管创伤在事故现场、急诊科或重症监护病房都可能是致命的。疼痛管理是护理胸部受伤儿童的重要组成部分。在过去几年中，出现了多种方法，能更好地缓解疼痛，缩短恢复时间，且副作用更少。对采用患者自控镇痛（PCA）、硬膜外镇痛或肋间神经阻滞的儿童进行护理，需要特定的知识和评估技能。非药物性疼痛缓解方法可作为药物性方法的辅助手段。
