钝性创伤致深肺裂伤伴血胸的诊断与治疗。

Diagnosis and treatment of deep pulmonary laceration with intrathoracic hemorrhage from blunt trauma.

机构信息

Department of General Thoracic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.

出版信息

Ann Thorac Surg. 2010 Jan;89(1):232-8. doi: 10.1016/j.athoracsur.2009.09.041.

DOI:10.1016/j.athoracsur.2009.09.041

PMID:20103242

Abstract

BACKGROUND

Blunt chest trauma resulting in massive hemothorax requires immediate attention. We investigated the diagnostic and prognostic utility of various clinical factors in patients with deep pulmonary laceration caused by blunt chest trauma with a view toward interventional treatment.

METHODS

We reviewed 42 patients with deep pulmonary laceration resulting from blunt chest trauma who were treated between 1988 and 2008. Various clinical factors were compared between survivors and nonsurvivors.

RESULTS

Of the 42 patients, 29 (69%) survived. Median (25th, 75th percentile) systolic blood pressure at arrival was 102 (76, 121) mm Hg for survivors and 70 (60, 90) mm Hg for nonsurvivors (p = 0.015). The median heart rate at arrival was 107 (98, 120) beats/min for survivors and 130 (120, 140) beats/min for nonsurvivors (p = 0.014). Respiratory rate, Glasgow Coma Scale score, and arterial blood gas values did not affect prognosis. Blood loss through the chest tube at insertion was 500 (400, 700) mL for survivors and 700 (500, 1000) mL for nonsurvivors (p = 0.147) and within 2 hours of arrival was 850 (590, 1100) mm Hg and 1600 (1400, 2000) mL, respectively (p < 0.001). Blood loss during thoracotomy was 1170 (600, 1790) mL and 3500 (2000, 6690), respectively (p < 0.001).

CONCLUSIONS

In patients with deep pulmonary laceration, hemorrhagic shock with systolic blood pressure less than 80 mm Hg and heart rate more than 120 beats/min leads to a poor prognosis. Emergency thoracotomy and pulmonary lobectomy should be performed before the intrathoracic hemorrhage reaches 1200 mL.

摘要

背景

钝性胸部创伤导致大量血胸需要立即关注。我们研究了各种临床因素在因钝性胸部创伤导致的深度肺裂伤患者中的诊断和预后作用，以期为介入治疗提供依据。

方法

我们回顾了 1988 年至 2008 年间因钝性胸部创伤导致深度肺裂伤的 42 例患者。比较了存活者和非存活者之间的各种临床因素。

结果

42 例患者中，29 例（69%）存活。存活者到达时的收缩压中位数（25%、75%分位数）为 102（76、121）mmHg，而非存活者为 70（60、90）mmHg（p = 0.015）。到达时的心率中位数为 107（98、120）次/分，而非存活者为 130（120、140）次/分（p = 0.014）。呼吸频率、格拉斯哥昏迷评分和动脉血气值对预后没有影响。插入胸腔引流管时的失血量，存活者为 500（400、700）ml，非存活者为 700（500、1000）ml（p = 0.147），到达后 2 小时内的失血量分别为 850（590、1100）mmHg 和 1600（1400、2000）ml（p < 0.001）。开胸手术时的失血量分别为 1170（600、1790）ml 和 3500（2000、6690）ml（p < 0.001）。