Linton D M, Potgieter P D
S Afr Med J. 1982 Jun 12;61(24):917-9.
Conservative management of blunt chest trauma reduces morbidity in selected patients. We present a retrospective analysis of 50 patients with blunt chest trauma who were treated in the Respiratory Unit of Groote Schuur Hospital, Cape Town, during 1980. Conservative management was not possible in 21 patients because of severe associated injuries. The remaining 29 patients were treated either with continuous positive pressure ventilation (CPPV) or continuous positive airway pressure (CPAP) by face-mask and thoracic extradural analgesia. The conservatively treated patients spent less time in the Intensive Care Unit and had fewer complications. Thoracic extradural analgesia provides optimal pain relief with resultant increase in vital capacity and an improvement in arterial blood gas levels. Current management of blunt chest trauma is directed at early withdrawal of continuous ventilatory support as soon as this can be replaced either with thoracic extradural analgesia and CPAP by mask, or with CPAP by mask alone.
钝性胸部创伤的保守治疗可降低特定患者的发病率。我们对1980年在开普敦格罗特舒尔医院呼吸科接受治疗的50例钝性胸部创伤患者进行了回顾性分析。21例患者因严重合并伤无法进行保守治疗。其余29例患者采用面罩持续气道正压通气（CPAP）或持续正压通气（CPPV）联合胸段硬膜外镇痛治疗。保守治疗的患者在重症监护病房的时间更短，并发症更少。胸段硬膜外镇痛可提供最佳的疼痛缓解效果，从而增加肺活量并改善动脉血气水平。钝性胸部创伤的当前治疗方法是，一旦可以用胸段硬膜外镇痛联合面罩CPAP或仅用面罩CPAP替代持续通气支持，就尽早撤机。
