Byun Joung Hun, Kim Han Young
Department of Thoracic and Cardiovascular Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Korea.
Korean J Thorac Cardiovasc Surg. 2013 Apr;46(2):130-4. doi: 10.5090/kjtcs.2013.46.2.130. Epub 2013 Apr 9.
Rib fractures are the most common type of thoracic trauma and cause other complications. We explored the risk factors for pneumonia in patients with multiple rib fractures.
Four hundred and eighteen patients who visited our hospital with multiple rib fractures between January 2002 and December 2008 were retrospectively reviewed. Chest X-rays and chest computed tomography were used to identify injury severity. Patients with only a single rib fracture or who were transferred to another hospital within 2 days were excluded.
There were 327 male patients (78%), and the median age was 53 years. The etiologies of the patients' trauma included traffic accidents in 164 cases (39%), falls in 78 cases (19%), slipping and falling in 90 (22%), pedestrian accidents in 30 (7%), industrial accidents in 41 (10%), and assault in 15 (4%). The median number of rib fractures was 4.8. Pulmonary complications including flail chest (2.3%), lung contusion (22%), hemothorax (62%), pneumothorax (31%), and hemopneumothorax (20%) occurred. Chest tubes were inserted into the thoracic cavity in 216 cases (52%), and the median duration of chest tube insertion was 10.26 days. The Injury Severity Score (ISS) and rib score had a median of 15.27 and 6.9, respectively. Pneumonia occurred in 18 cases (4.3%). Of the total cases, 33% of the cases were managed in the intensive care unit (ICU), and the median duration of stay in the ICU was 7.74 days. Antibiotics were administered in 399 patients (95%) for a median of 10.53 days. Antibiotics were used for more than 6 days in 284 patients (68%). The factors affecting pneumonia in patients with multiple rib fractures in multivariate analysis included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). The use of antibiotics was not associated with the occurrence of pneumonia (p=0.28). In-hospital mortality was 5.3% (n=22).
The factors affecting risk of pneumonia in patients with multiple rib fractures included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). Elderly patients with multiple traumas have a high risk of pneumonia and should be treated accordingly.
肋骨骨折是最常见的胸部创伤类型，并会引发其他并发症。我们探讨了多根肋骨骨折患者发生肺炎的危险因素。
回顾性分析了2002年1月至2008年12月间因多根肋骨骨折前来我院就诊的418例患者。采用胸部X线和胸部计算机断层扫描来确定损伤严重程度。仅单根肋骨骨折或在2天内转至其他医院的患者被排除。
男性患者327例（78%），中位年龄为53岁。患者创伤的病因包括交通事故164例（39%）、跌倒78例（19%）、滑倒90例（22%）、行人事故30例（7%）、工业事故41例（10%）以及袭击15例（4%）。肋骨骨折的中位数量为4.8根。发生了包括连枷胸（2.3%）、肺挫伤（22%）、血胸（62%）、气胸（31%）和血气胸（20%）在内的肺部并发症。216例（52%）患者胸腔内插入了胸管，胸管插入的中位持续时间为10.26天。损伤严重程度评分（ISS）和肋骨评分的中位数分别为15.27和6.9。18例（4.3%）患者发生了肺炎。在所有病例中，33%的病例在重症监护病房（ICU）接受治疗，在ICU的中位住院时间为7.74天。399例（95%）患者使用了抗生素，中位使用时间为10.53天。284例（68%）患者使用抗生素超过6天。多因素分析中影响多根肋骨骨折患者发生肺炎的因素包括年龄（p = 0.004）、ISS（p < 0.001）和肋骨评分（p = 0.038）。抗生素的使用与肺炎的发生无关（p = 0.28）。住院死亡率为5.3%（n = 22）。
影响多根肋骨骨折患者发生肺炎风险的因素包括年龄（p = 0.004）、ISS（p < 0.001）和肋骨评分（p = 0.038）。多发伤的老年患者发生肺炎的风险较高，应给予相应治疗。
