Störmann Philipp, Krämer Sebastian, Raab Stephan, Kalverkamp Sebastian, Graeff Pascal
Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland.
Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland.
Zentralbl Chir. 2023 Feb;148(1):50-56. doi: 10.1055/a-1991-9599. Epub 2023 Jan 30.
Pulmonary contusion usually occurs in combination with other injuries and is indicative of a high level of force. Especially in multiply injured patients, pulmonary contusions are frequently detected. The injury is characterised by dynamic development, which might result in difficulties in recognising the actual extent of the injury at an early stage. Subsequently, correct classification of the extent of injury and appropriate initiation of therapeutic steps are essential to achieve the best possible outcome. The main goal of all therapeutic measures is to preserve lung function as best as possible and to avoid associated complications such as the development of pneumonia or Acute Respiratory Distress Syndrome (ARDS).The present report from the interdisciplinary working group "Chest Trauma" of the German Society for Trauma Surgery (DGU) and the German Society for Thoracic Surgery (DGT) includes an extensive literature review on the background, diagnosis and treatment of pulmonary contusion. Without exception, papers with a low level of evidence were included due to the lack of studies with large cohorts of patients or randomised controlled studies. Thus, the recommendations given in the present article correspond to a consensus of the aforementioned interdisciplinary working group.Computed tomography (CT) of the chest is recommended for initial diagnosis; the extent of pulmonary contusion correlates with the incidence and severity of complications. A conventional chest X-ray may initially underestimate the injury, but is useful during short-term follow-up.Therapy for pulmonary contusion is multimodal and symptom-based. In particular, intensive care therapy with lung-protective ventilation and patient positioning are key factors of treatment. In addition to invasive ventilation, non-invasive ventilation should be considered if the patient's comorbidities and compliance allows this. Furthermore, depending on the extent of the lung injury and the general patient's condition, ECMO therapy may be considered as an ultima ratio. In particular, this should only be performed at specialised hospitals, which is why patient assignment or anticipation of early transfer of the patient should be anticipated at an early time during the course.
肺挫伤通常与其他损伤同时发生，提示外力作用较大。尤其是在多发伤患者中，肺挫伤很常见。该损伤的特点是动态发展，这可能导致早期难以识别损伤的实际范围。因此，准确分类损伤程度并适时启动治疗措施对于取得最佳治疗效果至关重要。所有治疗措施的主要目标是尽可能保护肺功能，避免相关并发症，如肺炎或急性呼吸窘迫综合征（ARDS）的发生。德国创伤外科学会（DGU）和德国胸外科学会（DGT）的跨学科工作组“胸部创伤”的本报告包括对肺挫伤的背景、诊断和治疗的广泛文献综述。由于缺乏大规模患者队列研究或随机对照研究，无一例外纳入了证据水平较低的论文。因此，本文给出的建议是上述跨学科工作组的共识。建议采用胸部计算机断层扫描（CT）进行初步诊断；肺挫伤的程度与并发症的发生率和严重程度相关。传统胸部X线检查最初可能会低估损伤情况，但在短期随访中很有用。肺挫伤的治疗是多模式的且基于症状。特别是，采用肺保护性通气的重症监护治疗和患者体位摆放是治疗的关键因素。除了有创通气，如果患者的合并症和依从性允许，也应考虑无创通气。此外，根据肺损伤的程度和患者的一般状况，体外膜肺氧合（ECMO）治疗可作为最后的手段。特别是，这只能在专科医院进行，这就是为什么在病程早期就应考虑患者分配或尽早预计患者的早期转运。
