Shimazu T, Sugimoto H, Nishide K, Terai C, Ohashi N, Yoshioka T, Sugimoto T
Department of Traumatology, Osaka University Medical School, Japan.
Am J Emerg Med. 1988 Sep;6(5):427-34. doi: 10.1016/0735-6757(88)90239-2.
The clinical management of 12 patients with major intrathoracic tracheobronchial rupture (complete, 3; incomplete, 9) due to blunt trauma has been reviewed and compared with that of two groups of patients with chest injuries not involving the tracheobronchial tree, 17 patients with multiple rib fractures and 17 with chest injuries requiring thoracotomy for control of pneumothorax and hemothorax. The effect of injury on ventilatory function was significantly greater in the patients with tracheobronchial injury in whom an elevated PCO2 at the time of admission was associated with a poor prognosis. Conventional ventilatory management with endotracheal intubation and positive pressure ventilation causing increased air leakage produced further deterioration of pulmonary function in four of the patients with tracheobronchial disruption. The use of a double-lumen endobronchial tube in two patients with tracheobronchial rupture facilitated ventilatory support and subsequent operative management.
回顾了12例因钝性创伤导致胸段气管支气管严重破裂（完全破裂3例，不完全破裂9例）患者的临床处理情况，并与两组未累及气管支气管树的胸部损伤患者进行了比较，一组是17例多根肋骨骨折患者，另一组是17例因气胸和血胸需要开胸手术控制的胸部损伤患者。气管支气管损伤患者中，损伤对通气功能的影响明显更大，入院时PCO2升高与预后不良相关。4例气管支气管破裂患者采用气管插管和正压通气的传统通气管理导致漏气增加，使肺功能进一步恶化。2例气管支气管破裂患者使用双腔支气管导管有助于通气支持及后续手术处理。
