Tan B K K, Pothiawala S, Ong M E H
Department of Emergency Medicine, Singapore General Hospital, Singapore -
Minerva Chir. 2013 Jun;68(3):241-50.
We aim to assess which group of patients with blunt or penetrating chest trauma will benefit from emergency thoracotomy (ET) and have a good functional outcome.
A literature search was conducted using PUBMED, EMBASE, Science Direct and Google Scholar. The search terms used were: emergency thoracotomy; penetrating chest injury; blunt chest injury. The inclusion criteria were human trials, studies and case series on emergency or emergency department thoracotomy in adults and all papers that compared outcomes between patients with penetrating and blunt chest injury. All meta analysis, case reports, thoracotomies in children and the pediatric population, thoracotomies that were not performed in an emergency setting and papers that did not include data on both penetrating and blunt injuries were excluded.
A total of 20 papers met the above criteria. More ETs were performed in patients with penetrating chest injury (PCI); range 3 to 670, mean 122 compared to blunt chest injury (BCI); range 5 to 319, mean of 51. Survival of the patients who underwent ET seemed to be higher in the PCI group; range 2.7% to 37.5%, mean 17.0% compared to BCI group; range 0.6% to 60%, mean of 4.6%. Mean Survival rate was higher (70.9%) for stab wounds compared to gunshot wounds (29.2%). The mean percentage of neurologically intact survivors among PCI survivors 86% (164) were higher compared to the BCI group 12% (8).
Patients most likely to benefit from ET are those with penetrating chest injury, signs of life at scene or on arrival in the ED or pericardial tamponade. Hospitals should develop specific guidelines for emergency thoracotomy for patients with penetrating trauma, pericardial tamponade and witnessed cardiac arrest, as they are most likely to benefit from ET with improved chances of survival and good neurological outcome.
我们旨在评估哪一组钝性或穿透性胸部创伤患者将从急诊开胸手术（ET）中获益并获得良好的功能结局。
使用PUBMED、EMBASE、科学Direct和谷歌学术进行文献检索。使用的检索词为：急诊开胸手术；穿透性胸部损伤；钝性胸部损伤。纳入标准为关于成人急诊或急诊科开胸手术的人体试验、研究和病例系列，以及所有比较穿透性和钝性胸部损伤患者结局的论文。所有荟萃分析、病例报告、儿童及儿科人群的开胸手术、非急诊情况下进行的开胸手术以及未包括穿透性和钝性损伤数据的论文均被排除。
共有20篇论文符合上述标准。穿透性胸部损伤（PCI）患者接受ET的次数更多；范围为3至670次，平均122次，而钝性胸部损伤（BCI）患者；范围为5至319次，平均51次。接受ET的患者生存率在PCI组似乎更高；范围为2.7%至37.5%，平均17.0%，而BCI组；范围为0.6%至60%，平均4.6%。刺伤的平均生存率（70.9%）高于枪伤（29.2%）。PCI幸存者中神经功能完好幸存者的平均百分比86%（164例）高于BCI组的12%（8例）。
最有可能从ET中获益的患者是那些有穿透性胸部损伤、现场或到达急诊科时有生命体征或心包填塞的患者。医院应为穿透性创伤、心包填塞和目击心脏骤停的患者制定急诊开胸手术的具体指南，因为他们最有可能从ET中获益，生存机会增加且神经功能结局良好。
