Carli P, Lejay M
Département d'anesthésie-réanimation, SAMU de Paris, Hôpital Necker.
Rev Prat. 1997 May 1;47(9):951-7.
Blunt thoracic trauma are frequent and often severe. Their management is improved in the prehospital settings by the involvement of a medical team, and the admission in a specialized trauma center. Diagnostic and therapeutic steps are closely linked. They are based on the stabilization of life threatening problems and the appropriate use of recent advances in medical imaging. Endotracheal intubation and mechanical ventilation are indicated for respiratory distress. Immediate surgical management is mandatory for an hypovolemic shock related to massive hemothorax. On the contrary, multiple ribs fractures and flail chest without major pulmonary contusion are managed with regional analgesia allowing effective physiotherapy and avoiding the infectious complications related to prolonged mechanical ventilation.
钝性胸部创伤很常见且往往较为严重。通过医疗团队的参与以及在专门的创伤中心入院治疗，可改善其在院前环境中的管理。诊断和治疗步骤紧密相连。它们基于对危及生命问题的稳定处理以及对医学成像最新进展的恰当运用。对于呼吸窘迫，需进行气管插管和机械通气。对于与大量血胸相关的低血容量性休克，必须立即进行手术治疗。相反，对于无严重肺挫伤的多根肋骨骨折和连枷胸，采用区域镇痛进行处理，这样既能进行有效的物理治疗，又能避免与长时间机械通气相关的感染并发症。
