Hawkins M L, Carraway R P, Ross S E, Johnson R C, Tyndal E C, Laws H L
Medical College of Georgia, Augusta 30912.
Am Surg. 1988 Mar;54(3):148-52.
Blunt chest trauma occurs in up to 50 per cent of all fatal motor vehicle accidents and is the primary cause of death in 12-25 per cent; yet only 15 per cent of patients with chest trauma arriving alive to the emergency department require early thoracotomy. Pulmonary artery disruption from blunt trauma is extremely rare. Two patients both women, older and obese with multiple rib fractures and little pulmonary parenchymal damage are reported. Neither had injury to the aorta, heart or intra-abdominal organs. One patient survived after lateral repair of the left main pulmonary artery and the other exsanguinated from a laceration of the right main pulmonary artery. Intrapericardial exposure of the proximal pulmonary arteries may be necessary for control of hemorrhage. Trauma surgeons should be familiar with this technique. Indications for immediate thoracotomy should include: massive hemothorax (greater than 1000 ml), continued bleeding greater than 300 ml in the first hour, bleeding greater than 200 ml/hr for 5 hours, or increasing hemothorax in spite of tube thoracostomy. Close adherence to these guidelines would have allowed both patients to be explored earlier.
钝性胸部创伤在所有致命机动车事故中发生率高达50%，是12%至25%患者的主要死因；然而，仅15%胸部创伤患者在抵达急诊科时存活且需要早期开胸手术。钝性创伤导致的肺动脉破裂极为罕见。本文报告了两名女性患者，年龄较大且肥胖，均有多处肋骨骨折，肺实质损伤较小。两人均未伤及主动脉、心脏或腹腔内器官。一名患者在对左主肺动脉进行外侧修复后存活，另一名患者因右主肺动脉撕裂而失血过多死亡。为控制出血，可能需要在心包内暴露近端肺动脉。创伤外科医生应熟悉此技术。立即开胸手术的指征应包括：大量血胸（超过1000毫升）、首小时持续出血超过300毫升、5小时内出血超过200毫升/小时或尽管进行了胸腔闭式引流但血胸仍在增加。严格遵循这些指南本可使两名患者更早接受探查。
