Richardson J D, Adams L, Flint L M
Ann Surg. 1982 Oct;196(4):481-7. doi: 10.1097/00000658-198210000-00012.
Four hundred and twenty-seven patients with severe blunt chest trauma were treated resulting in (1) flail chest, (2) pulmonary contusions, (3) pneumothorax, (4) hemothorax, or (5) multiple rib fracture. The need for endotracheal intubation and mechanical ventilation was determined selectively by standard clinical criteria. Avoidance of fluid overload and vigorous pulmonary toilet was attempted in all patients. Three hundred and twenty-eight patients were treated by nonintubation; 318 patients (96.6%) had a successful outcome, while ten required intubation. Only one patient died. The 99 patients who required intubation and mechanical ventilation had a high mortality because of associated shock and head injury; however, the total mortality for the entire group of patients was 6.5%, with only 1.4% mortality caused by pulmonary injury. The incidence of pneumonia was high (51%), but there was only a 4% incidence of tracheostomy complications. Flail chest and pulmonary contusion without flail chest occurred in 95 and 135 patients, respectively. Half of the flail chest patients were intubated, but 69.5% were intubated less than three days. Twenty per cent of the patients with pulmonary contusion required mechanical ventilation, usually for less than three days. This study demonstrates that patients with severe blunt chest trauma can be managed safely by selective intubation and mechanical, ventilation and that the incidence of complications associated with controlled mechanical ventilation can be greatly reduced.
427例严重钝性胸部创伤患者接受了治疗，导致出现（1）连枷胸、（2）肺挫伤、（3）气胸、（4）血胸或（5）多根肋骨骨折。根据标准临床标准选择性地确定是否需要气管插管和机械通气。所有患者均试图避免液体超负荷和积极进行肺部灌洗。328例患者接受了非插管治疗；318例患者（96.6%）治疗成功，10例需要插管。仅1例患者死亡。99例需要插管和机械通气的患者因合并休克和头部损伤而死亡率较高；然而，整个患者组的总死亡率为6.5%，仅1.4%的死亡率由肺部损伤导致。肺炎发生率较高（51%），但气管切开术并发症发生率仅为4%。连枷胸患者95例，无连枷胸的肺挫伤患者135例。连枷胸患者中有一半接受了插管，但69.5%的患者插管时间少于3天。20%的肺挫伤患者需要机械通气，通常时间少于3天。本研究表明，严重钝性胸部创伤患者可通过选择性插管和机械通气安全管理，且与控制性机械通气相关的并发症发生率可大幅降低。
