Department of Surgery, The Queen's Medical Center, HI, USA.
Am Surg. 2021 Sep;87(9):1468-1473. doi: 10.1177/0003134820966278. Epub 2020 Dec 27.
Patient factors associated with delayed respiratory failure (DRF) after blunt chest trauma are not well documented. Earlier identification and closer monitoring may improve outcomes for these patients. The purpose of this study was to identify the prevalence and clinical predictors of DRF in patients after blunt chest trauma.
A retrospective review of adult patients admitted to a Level 1 trauma center after blunt chest trauma between January 1, 2009 and December 31, 2013, was conducted. Patients with early respiratory failure were compared to patients with DRF using Fisher's exact tests, chi square, and Student's t-tests. A -value of <.05 was considered significant.
1299 patients had blunt chest trauma and at least 1 rib fracture, of which 830 met inclusion criteria. 5.8% of patients progressed to respiratory failure. Respiratory failure was delayed in 25% of these patients. DRF patients had significantly lower ISS (16.5 vs. 22.7, = .04), more bilateral rib fractures (66.7% vs. 28.7%, = .02) and fewer pulmonary contusions (16.7% vs. 50.0%, = .04).
Injury patterns, including bilateral rib fractures without pulmonary contusions and low but severe Injury Severity Score burden, may help identify high-risk patients who may benefit from closer monitoring and more aggressive therapy.
与钝性胸部创伤后延迟性呼吸衰竭（DRF）相关的患者因素尚未得到充分记录。更早的识别和更密切的监测可能会改善这些患者的结局。本研究的目的是确定钝性胸部创伤后患者 DRF 的患病率和临床预测因素。
对 2009 年 1 月 1 日至 2013 年 12 月 31 日期间在一级创伤中心因钝性胸部创伤入院的成年患者进行了回顾性研究。使用 Fisher 确切检验、卡方检验和学生 t 检验比较早期呼吸衰竭患者和 DRF 患者。值 <.05 被认为具有统计学意义。
1299 例患者有钝性胸部创伤和至少 1 根肋骨骨折，其中 830 例符合纳入标准。5.8%的患者进展为呼吸衰竭。其中 25%的患者呼吸衰竭延迟。DRF 患者的 ISS 明显更低（16.5 比 22.7， =.04），双侧肋骨骨折的比例更高（66.7%比 28.7%， =.02），而肺挫伤的比例更低（16.7%比 50.0%， =.04）。
损伤模式，包括无肺挫伤的双侧肋骨骨折和低但严重的损伤严重程度评分负担，可能有助于识别高危患者，这些患者可能受益于更密切的监测和更积极的治疗。
