Department of Thoracic Surgery, Faculty of Medicine Dicle University, 21280 Diyarbakir, Turkey.
Injury. 2011 Sep;42(9):900-4. doi: 10.1016/j.injury.2010.02.004.
Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality.
A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded.
A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 9.33 (range, 15–54) years. The mean LOS was 10.65 8.30 (range, 5–65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 9.92 days; stab wound, 8.76 6.42 days, p < 0.001). Patients who died had a significantly lower systolic blood pressure (SBP) on presentation in the emergency room (42.94 36.702 mm Hg) compared with those who survived (83.96 27.842 mm Hg, p = 0.001). The overall mortality rate was 10.8% (n = 17). Mortality for patients with stab wounds was 8/93 (8.6%) compared with 9/65 (13.8%) for patients with gunshot wounds (p = 0.29). Concomitant abdominal injuries (p = 0.01), diaphragmatic injury (p = 0.01), ISS (p = 0.001), chest AIS score (p < 0.05), ongoing output (p = 0.001), blood transfusion volume (p < 0.01) and SBP (p = 0.001) were associated with mortality.
Penetrating injuries to the chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury.
穿透性胸部创伤是一个常见且具有挑战性的问题，但大多数此类创伤可以非手术方式治疗。本研究旨在描述穿透性胸部创伤的发生率和最终采用的手术治疗方法，以及诊断、并发症、发病率和死亡率。
对 9 年来接受穿透性胸部创伤手术治疗的患者进行回顾性研究。记录患者的创伤机制、性别、年龄、生理和预后参数，包括创伤严重程度评分（ISS）、胸部简明损伤评分（AIS）、肺损伤评分、合并伤、从入院到手术室的时间、输血需求、开胸指征、术中发现、手术程序、住院时间（LOS）和死亡率。
共调查了 1123 例因穿透性胸部创伤入院的患者。其中，158 例（93 例刺伤，65 例枪伤）在穿透伤后 24 小时内行开胸术。146 例（92.4%）为男性，12 例（7.6%）为女性，平均年龄为 25.72±9.33 岁（范围 15-54 岁）。平均 LOS 为 10.65±8.30 天（范围 5-65 天）。因枪伤入院的患者 LOS 明显长于因刺伤入院的患者（枪伤 13.53±9.92 天；刺伤 8.76±6.42 天，p<0.001）。死亡患者入院时的收缩压（SBP）明显低于存活患者（SBP：42.94±36.702mmHg 与 83.96±27.842mmHg，p=0.001）。总死亡率为 10.8%（n=17）。刺伤患者的死亡率为 8/93（8.6%），枪伤患者的死亡率为 9/65（13.8%）（p=0.29）。合并腹部损伤（p=0.01）、膈肌损伤（p=0.01）、ISS（p=0.001）、胸部 AIS 评分（p<0.05）、持续输出（p=0.001）、输血量（p<0.01）和 SBP（p=0.001）与死亡率相关。
穿透性胸部创伤需要开胸的情况并不常见，肺保护技术已成为治疗肺损伤最常用的方法。合并腹部损伤使死亡率增加 5 倍。影响死亡率的因素包括 ISS、胸部 AIS 评分、SBP、持续胸腔引流量、输血量、膈肌损伤和合并腹部损伤。
