摘要
目的：探讨以胸部损伤为主的严重多发伤的特点与救治对策，以提高救治效果。方法：按照损伤严重度评分法（ＩＳＳ），对６３例ＩＳＳ值≥２０分、以胸部损伤为主的严重多发伤患者，采取各种对策进行抢救治疗。除抗休克、给氧、紧急气管内插管外，行单侧胸腔闭式引流４５例次，双侧引流４例次，剖胸探查１４例次，机械辅助呼吸１８例次，人工辅助呼吸１１例次。辅助呼吸时间按损伤特点和病情不同而定。结果：抢救成功３９例，死亡２４例（其中２１例合并脑外伤）。ＩＳＳ值２０～３０分者死亡２例，存活１０例；３１～６０分者死亡１５例，存活２９例；≥６０分者死亡７例，无一例存活。结论：以胸部损伤为主的多发伤其伤情重，处理复杂，病死率高；其救治对策应遵循抢救诊断治疗或抢救与伤情估计同时进行的原则：及时采取气管内插管或气管切开，保持呼吸道通畅，抗休克，积极处理血气胸，降颅压及适时应用机械辅助呼吸等。
Objective:To study characteristics and treatment of chest trauma in patients with concomitant multiple injuries.Methods:Sixtythree cases of severe chest trauma with concomitant multiple injuries and injury severity scores(ISS)≥20 were treated with different strategies.In addition to antishock,delivery of oxygen and insertion of endotracheal tube,special measures were also used in these patients,including single lateral intercostal tube drainage in 45 cases,bilateral drainage in 4 cases,surgical exploration in 14 cases,mechanical ventilation in 18 cases,and artificial respiration in 11 cases.Duration of assisted respiration was determined according to feature and severity of trauma.Results:Thirtynine patients were saved successfully.Twenty one out of 24 death cases were combined with head injury.Of patients whose ISS values were within the range of 20～30 and 31￣60,2 and 15 died,and 10 and 29 survived,respectively.When ISS value was over 60,no one survived.Conclusions:The characteristics of chest trauma with concomitant multiple injuries are severe,complicated and with high mortality.The principles of treatment should be conformed as follows:first aiddiagnosistreatment of firstaid and estimate of extent of trauma are performed at the same time.The rapeutic meas ures include immediate endotracheal intubation and tracheostomy to keep the airway patent,early treatment of shock and hemopneumothorax,reduction of intracranial pressure,and correct use of mechanical ventilation support.
出处
《中国危重病急救医学》
CAS
CSCD
1997年第7期427-429,共3页
Chinese Critical Care Medicine
关键词
胸部损伤
多发伤
损伤严重度评分
chest trauma
multiple injury
injury severity scores
