Kish G, Kozloff L, Joseph W L, Adkins P C
Ann Thorac Surg. 1976 Jul;22(1):23-8. doi: 10.1016/s0003-4975(10)63946-x.
Trauma to the thorax represents a significant portion of injuries seen in an inner-city emergency room. Although most of these patients may be successfully managed without thoracotomy, a certain percentage require operative intervention either immediately or within several hours. The records of more than 380 patients with major chest trauma seen in recent years have been reviewed. Three hundred twenty-one of these patients (84%) required only good supportive measures such as correction of hypovolemia, temporary ventilatory support, tube thoracostomy, and careful observation. Forty-four additional patients (12%) required immediate operation following preliminary resuscitative treatment. Indications included hemorrhage, cardiac tamponade, injury to a great vessel, and rupture of the diaphragm. There were 10 deaths in this group. In 15 other individuals (4%) delayed operation was undertaken following careful reappraisal of initial injuries by continued examination, monitoring of vital signs, and appropriate roentgenographic and laboratory studies. Indications for delayed operation included continued or recurrent bleeding, widening of the mediastinum, hemoptysis, and recurrent hemothorax. There was only 1 death in this group. Thus, although it may be clear which patients require immediate operation, only careful and continuous monitoring can identify those who initially appear to be in stable condition but eventually will require exploration.
胸部创伤占城市急诊室所见损伤的很大一部分。尽管这些患者中的大多数无需开胸手术即可成功处理，但仍有一定比例的患者需要立即或在数小时内进行手术干预。对近年来380多名严重胸部创伤患者的记录进行了回顾。其中321名患者（84%）仅需要良好的支持性措施，如纠正血容量不足、临时通气支持、胸腔闭式引流术以及仔细观察。另外44名患者（12%）在初步复苏治疗后需要立即手术。指征包括出血、心脏压塞、大血管损伤和膈肌破裂。该组中有10例死亡。另有15名患者（4%）在通过持续检查、生命体征监测以及适当的X线和实验室检查对初始损伤进行仔细重新评估后接受了延迟手术。延迟手术的指征包括持续或反复出血、纵隔增宽、咯血和反复血胸。该组中仅有1例死亡。因此，尽管哪些患者需要立即手术可能很明确，但只有通过仔细且持续的监测才能识别出那些最初看似病情稳定但最终仍需要进行探查的患者。
