Department of Surgery, Division of General Surgery, Stanford University, United States; Department of Epidemiology and Population Health, Stanford University, United States; Surgeons Writing about Trauma, Stanford University, United States.
Department of Surgery, Division of General Surgery, Stanford University, United States; Surgeons Writing about Trauma, Stanford University, United States.
Am J Surg. 2021 Jan;221(1):211-215. doi: 10.1016/j.amjsurg.2020.07.022. Epub 2020 Jul 31.
Pulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion.
We identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality.
Among 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16-33%], respiratory failure 40% [95%CI: 31-50%], and intubation 46% [95%CI: 33-61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications.
There is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.
肺挫裂伤较为常见。计算机断层扫描（computed tomography，CT）可显示出广泛的挫伤肺容积谱，但肺挫裂伤是二分法定义的（单侧与双侧）。我们评估了在无肺挫伤、单侧肺挫伤和双侧肺挫伤的患者中，是否存在肺并发症风险呈逐步增加的情况。
我们利用美国最大的住院患者数据库，确定了因肋骨骨折住院的成年人。在进行倾向评分匹配无肺挫伤与单侧肺挫伤和双侧肺挫伤的患者，并调整残余混杂因素后，我们比较了肺炎、呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）、呼吸衰竭、插管和死亡率的风险。
在 148140 例有多处肋骨骨折的成年人中，19%的患者合并有肺挫伤。有肺挫伤的匹配患者肺炎风险增加 19%[95%CI：16-33%]，呼吸衰竭风险增加 40%[95%CI：31-50%]，插管风险增加 46%[95%CI：33-61%]。分层显示，双侧挫伤而不是单侧挫伤导致并发症风险增加。
挫伤肺容积与发生肺并发症的风险之间可能存在相关性；将肺挫裂伤二分法定义是不够的。要更好地理解这种相关性，需要确定临床上有意义的挫伤体积和相应的精细化分类系统。
