Velmahos G C, Degiannis E, Souter I, Allwood A C, Saadia R
Department of Surgery, Baragwanath Hospital, Johannesburg, South Africa.
Arch Surg. 1995 Jul;130(7):774-7. doi: 10.1001/archsurg.1995.01430070096019.
To audit emergency department thoracotomies from January 1981 to May 1993.
Retrospective analysis of case records.
A large (3000-bed) tertiary care academic hospital; the department of general surgery (including trauma) consists of 360 beds.
All patients who underwent a thoracotomy in the emergency department during the above period.
An emergency department thoracotomy was performed on trauma patients with recordable vital signs and rapid deterioration and on patients with uncontrollable bleeding or profound hypotension not responsive to resuscitation. The procedure was performed either on the resuscitation trolley in the emergency department or in the adjacent operating room.
Survival and subsequent neurological function after thoracotomy.
There were 312 stab injuries, 358 gunshot injuries, and 176 blunt injuries. Survival occurred in 26 stab-wound cases (8.3%), in 16 gunshot cases (4.4%), and in one blunt injury case (0.6%). There was one patient with neurological impairment in each of the three injury groups. Those with penetrating chest injuries had the best survival rate (20%), and the survival rate for penetrating abdominal trauma was 6.8%.
Emergency department thoracotomies have a definite role in the management of trauma patients. The best results are obtained in patients with penetrating chest injuries.
审核1981年1月至1993年5月期间的急诊科开胸手术情况。
对病例记录进行回顾性分析。
一家大型（拥有3000张床位）的三级护理学术医院；普通外科（包括创伤外科）有360张床位。
上述期间在急诊科接受开胸手术的所有患者。
对有可记录生命体征且病情迅速恶化的创伤患者，以及对出血无法控制或对复苏无反应的严重低血压患者实施急诊科开胸手术。该手术在急诊科的复苏推车上或相邻的手术室进行。
开胸手术后的生存率及随后的神经功能。
有312例刺伤、358例枪伤和176例钝性伤。26例刺伤患者（8.3%）、16例枪伤患者（4.4%）和1例钝性伤患者（0.6%）存活。三个损伤组各有1例患者出现神经功能障碍。穿透性胸部损伤患者的生存率最高（20%），穿透性腹部创伤患者的生存率为6.8%。
急诊科开胸手术在创伤患者的治疗中具有明确作用。穿透性胸部损伤患者的手术效果最佳。
