Kerr T M, Sood R, Buckman R F, Gelman J, Grosh J
Shock/Trauma Service, Temple University Hospital, Philadelphia.
Surg Gynecol Obstet. 1989 Sep;169(3):223-5.
Stab wounds of the chest may be associated with a spectrum of injuries ranging from the lethal to the insignificant. The management of asymptomatic patients with stab wounds of the chest is controversial. The results of previous reports have asserted that asymptomatic patients with stab wounds of the chest do not have delayed complications develop if roentgenograms of the chest taken six hours after the injury are normal. This "rule" has not been validated. A three year, prospective study of patients with stab wounds of the chest was done. Patients were excluded from the study if they had symptoms on arrival, evidence of physiologic derangement caused by intrathoracic injury, wounds near the subclavian vessels or precordial wounds. Patients with lower thoracic stab wounds were evaluated by diagnostic peritoneal lavage. If findings from lavage were negative, the patients were included in the study. One hundred and five patients met the criteria for inclusion in the study group. All of the patients were hospitalized and examined serially. All had roentgenograms of the chest performed at admission, at six hours and at 24 hours. Four patients had a pneumothorax or hemothorax develop between the time of admission and six hours of hospitalization. In the remaining 101 patients, none had a pneumothorax or hemothorax between six and 24 hours. No patient asymptomatic on admission had a tension pneumothorax develop later. No patient had delayed evidence of abdominal injury. An asymptomatic patient with a stab wound of the chest that is not precordial, not in proximity to the subclavian artery and not suspected of diaphragmatic penetration should be serially examined and have a follow-up roentgenogram of the chest at six hours. If the patient remains asymptomatic and the six hour film is normal, delayed complications are rarely, if ever, encountered and the patient does not require further studies or hospitalization. The six hour rule for stab wounds of the chest is valid.
胸部刺伤可能伴有一系列损伤，从致命伤至轻伤不等。对于胸部刺伤无症状患者的处理存在争议。既往报告结果称，胸部刺伤无症状患者若伤后6小时胸部X线片正常，则不会出现延迟性并发症。但这一“规则”尚未得到验证。我们对胸部刺伤患者进行了一项为期三年的前瞻性研究。若患者入院时有症状、有胸内损伤导致的生理紊乱证据、伤口靠近锁骨下血管或为心前区伤口，则将其排除在研究之外。对下胸部刺伤患者进行诊断性腹腔灌洗评估。若灌洗结果为阴性，则将患者纳入研究。105例患者符合纳入研究组的标准。所有患者均住院并接受系列检查。所有患者均在入院时、6小时及24小时进行胸部X线检查。4例患者在入院至住院6小时之间出现气胸或血胸。在其余101例患者中，6至24小时之间无人出现气胸或血胸。入院时无症状的患者均未随后出现张力性气胸。无患者出现腹部损伤的延迟证据。对于胸部刺伤但非心前区、不靠近锁骨下动脉且不怀疑有膈肌穿透的无症状患者，应进行系列检查，并在6小时时进行胸部X线复查。若患者仍无症状且6小时胸片正常，则很少（如有）会出现延迟性并发症，患者无需进一步检查或住院。胸部刺伤的6小时规则是有效的。
