急诊胸部创伤的处理：1139 例分析。
Management of thoracic trauma in emergency service: Analysis of 1139 cases.
机构信息
Isa Dongel, Dept. of Thoracic Surgery, Suleyman Demirel University, Isparta, Turkey.
Abuzer Coskun, Dept. of Emergency, Cumhuriyet University, Sivas, Turkey.
出版信息
Pak J Med Sci. 2013 Jan;29(1):58-63. doi: 10.12669/pjms.291.2704.
OBJECTIVE
Thoracic trauma is a common cause of significant morbidity and mortality. This study presents a series of thoracic trauma with the aim to assess epidemiologic features, distribution of pathologies, additional systemic injuries, diagnosis, management and outcome.
METHODOLOGY
Between January 2007 and December 2011, all patients with thorax trauma admitted to the emergency service of our hospital were retrospectively reviewed with respect to age, gender, etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities, referral and outcome.
RESULTS
A total of 1139 patients with thorax trauma were included in the study. Of these, 698 (61.3%) were male and 441 (38.7%) were female, and the average age was 54.17±17.39 years. 1090 (95.7%) of the patients had blunt trauma, whereas 49 (4.3%) had penetrating trauma. Etiological factors were falls in 792 (69.5%), motor vehicle accidents in 259 (22.8%), animal related accidents in 39 (3.4%) and penetrating injuries in 49 (4.2%) patients. It was found that 229 (20%) patients had single, 101 (8.9%) had double, 5 (3%) had three or more, 10 (0.9%) had bilateral rib fractures and 19 (1.7%) had sternal fracture. Pneumothorax was diagnosed in 58 (5.1%) patients, whereas hemothorax, hemopneuomothorax and other system injuries were diagnosed in 36 (3.2%), 38(3.3%) and 292 (25.6%) respectively. In our series, thirteen patients (mortality rate 1.1%) died as result of hemorrhagic shock (n=8), respiratory distress (n=3) and severe multiple trauma (n=2).
CONCLUSION
Although majority of the patients with thorax trauma receive treatment as outpatients; thoracic traumas may be a life threatening condition, and should be identified and treated immediately. Mortality varies based on etiological factors, additional systemic pathologies, capabilities of the hospital especially diagnostic and treatment facilities in emergency services. We believe that a multidisciplinary approach to the patients with severe thorax trauma, and the opportunities of emergency bedside thoracotomy in emergency services will significantly reduce the morbidity and mortality.
目的
胸部创伤是导致严重发病率和死亡率的常见原因。本研究报告了一系列胸部创伤病例，旨在评估其流行病学特征、病变分布、全身合并伤、诊断、治疗方法和结局。
方法
2007 年 1 月至 2011 年 12 月，回顾性分析我院急诊科收治的所有胸部创伤患者的年龄、性别、病因、病变分布、全身合并伤、诊断、治疗方式、转归等资料。
结果
共纳入 1139 例胸部创伤患者，其中男 698 例（61.3%），女 441 例（38.7%），平均年龄为 54.17±17.39 岁。1090 例（95.7%）为钝性创伤，49 例（4.3%）为穿透性创伤。病因主要为坠落伤 792 例（69.5%）、机动车事故 259 例（22.8%）、动物相关伤 39 例（3.4%）、穿透伤 49 例（4.2%）。229 例（20.1%）为单发伤，101 例（8.9%）为多发伤，5 例（0.4%）为 3 处以上损伤，10 例（0.9%）为双侧肋骨骨折，19 例（1.7%）为胸骨骨折。58 例（5.1%）患者诊断为气胸，36 例（3.2%）、38 例（3.3%）、292 例（25.6%）分别诊断为血胸、血气胸和其他系统合并伤。本组 13 例（死亡率 1.1%）患者因失血性休克（n=8）、呼吸窘迫（n=3）和严重多发伤（n=2）死亡。
结论
尽管大多数胸部创伤患者接受门诊治疗，但胸部创伤可能危及生命，应立即识别和治疗。死亡率取决于病因、全身合并症、医院能力，尤其是急诊科的诊断和治疗设施。我们认为，对严重胸部创伤患者采用多学科方法，并在急诊科进行紧急床边开胸术，将显著降低发病率和死亡率。
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