Garramone R R, Jacobs L M, Sahdev P
Department of EMS/Trauma, Hartford Hospital, Connecticut 06115.
Surg Gynecol Obstet. 1991 Oct;173(4):257-61.
Of 457 patients with multisystem injuries undergoing abdominal computed tomographic (CT) scan, 26 patients were found to have 31 pneumothoraces. None of these were apparent on prior roentgenograms of the chest. Each pneumothorax was quantified by measuring its maximal width in millimeters and the number of 10 millimeter CT sections on which it appeared. Serial roentgenograms of the chest and patient charts were reviewed. The major factor determining the clinical course and management of these pneumothoraces was size. Seventeen per cent of pneumothoraces measuring less than 5 X 80 millimeters (group 1) and 85 per cent of those measuring greater than or equal to 5 X 80 millimeters (group 2) had tube thoracostomy performed. The percentage of pneumothoraces in each group with positive pressure ventilation was 55 and 77 per cent, respectively. Our results suggest that such occult pneumothoraces may be managed with close observation if they measure less than 5 X 80 millimeters, whether or not the patient is to receive positive pressure ventilation. Larger pneumothoraces and those associated with more than two rib fractures may require early treatment.
在457例接受腹部计算机断层扫描（CT）的多系统损伤患者中，发现26例患者有31处气胸。这些气胸在之前的胸部X线片上均未显示。通过测量每处气胸的最大宽度（以毫米为单位）及其出现的10毫米CT层面数量来进行量化。回顾了胸部的系列X线片和患者病历。决定这些气胸临床病程和处理方式的主要因素是大小。测量值小于5×80毫米的气胸（第1组）中有17%以及测量值大于或等于5×80毫米的气胸（第2组）中有85%进行了胸腔闭式引流术。每组接受正压通气的气胸患者比例分别为55%和77%。我们的结果表明，如果这些隐匿性气胸测量值小于5×80毫米，无论患者是否接受正压通气，均可通过密切观察来处理。较大的气胸以及与两根以上肋骨骨折相关的气胸可能需要早期治疗。
