Alisha Chaudhury, Gajanan Gaude, Jyothi Hattiholi
Senior Resident, Department of Pulmonary Medicine, KLE University's J. N. Medical College , Belgaum, India .
Professor and Head, Department of Pulmonary Medicine, KLE University's J. N. Medical College , Belgaum, India .
J Clin Diagn Res. 2015 Aug;9(8):OC17-9. doi: 10.7860/JCDR/2015/13285.6375. Epub 2015 Aug 1.
Thoracic injury and its complications are responsible for as much as 25% for blunt trauma mortality. Pulmonary contusion occurs in 30%-75% of these cases. Despite advances in pulmonary care and intensive care management pulmonary contusion still contributes to higher mortality and morbidity for patients with severe injuries.
To assess the outcome of pulmonary contusions in patients with chest trauma and various factors determining mortality in these patients.
A retrospective case study, over a period of one year, of all chest trauma cases with pulmonary contusions confirmed by X-rays or CT scan of thorax, were included in the study. All the cases were assessed for age, associated injuries, APACHE II score, SAPS II score, SOFA score, paO2/Fio2 ratio, fracture of ribs, presence of haemothorax or pneumothorax, ventilator and ICU days and finally hospital outcome.
A total of 16 cases of pulmonary contusions were included in the study. Five patients died during the ICU stay and 11 survived. All patients had associated injuries. There was significant difference seen in APACHE II score (p<0.001), SAPS II score (p<0.001), SOFA score (p<0.001), paO2/Fio2 ratio (p<0.022) and ventilator days (p<0.001) among the survivors and non-survivors. However, no significant difference was seen in presence of fracture of ribs and presence of either haemothorax or pneumothorax.
The risk factors that were associated with higher mortality in patients with pulmonary contusions following chest trauma were APACHE II score, SAPS II score, SOFA score, paO2/Fio2 ratio and ventilator days. Close monitoring to improve the gas exchange and better fluid management will help in improving the survival in these patients.
胸部损伤及其并发症占钝性创伤死亡率的25%。其中30%-75%的病例发生肺挫伤。尽管在肺部护理和重症监护管理方面取得了进展，但肺挫伤仍然导致重伤患者的死亡率和发病率升高。
评估胸部创伤患者肺挫伤的结果以及决定这些患者死亡率的各种因素。
一项回顾性病例研究，纳入了在一年时间内所有经胸部X线或CT扫描确诊为肺挫伤的胸部创伤病例。对所有病例评估年龄、合并伤、急性生理与慢性健康状况评分系统II（APACHE II）评分、简化急性生理学评分II（SAPS II）评分、序贯器官衰竭评估（SOFA）评分、动脉血氧分压/吸入氧分数值（paO2/Fio2）比值、肋骨骨折、血胸或气胸的存在情况、呼吸机使用天数和重症监护病房（ICU）住院天数，最后评估住院结局。
该研究共纳入16例肺挫伤病例。5例患者在ICU住院期间死亡，11例存活。所有患者均有合并伤。存活者和非存活者在APACHE II评分（p<0.001）、SAPS II评分（p<0.001）、SOFA评分（p<0.001）、paO2/Fio2比值（p<0.022）和呼吸机使用天数（p<0.001）方面存在显著差异。然而，在肋骨骨折的存在以及血胸或气胸的存在方面未发现显著差异。
胸部创伤后肺挫伤患者死亡率较高的危险因素是APACHE II评分、SAPS II评分、SOFA评分、paO2/Fio2比值和呼吸机使用天数。密切监测以改善气体交换和更好地进行液体管理将有助于提高这些患者的生存率。
