Clinical analysis of 1 250 patients with thoracic injuries_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

冷雪峰 ,  金健 , LI Aijian

成都大學附屬醫院心胸外科（成都 610081）;

Corresponding?author：

金健, Email: 577266594@qq.com

Keywords：

胸部損傷; 創傷中心; 回顧性研究

DOI：

10.7507/1007-4848.201507052

Video：

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目的總結胸部創傷流行病學及臨床特征，為創傷的預防和救治提供科學依據。方法回顧性分析 2005～2015 年我院胸心外科連續收治 1 250 例胸部創傷患者的臨床資料。根據患者傷情，分別采用無創性保守治療、胸腔閉式引流術、開胸探查止血術、肋骨內固定術及其他胸部及心臟創傷的修補術。觀察創傷患者致傷類型、創傷部位、治療方式與臨床預后以及 2012 年前后時間分布及其相關性。結果全組男 999 例（79.9%）、女 251 例（20.1%），平均年齡（44.0±17.7）歲。非穿透性損傷 885 例（70.8%），穿透性損傷 365 例（29.2%），死亡 8 例（0.64%）。肋骨骨折 766 例，骨折內固定手術干預占 16.1%（123/766），手術復位內固定患者平均住院時間明顯短于保守治療患者（9.55 dvs. 16.38 d，t=6.574，P=0.000）。2012 年后非穿透性損傷較 2012 年前有所升高（81.8%vs. 66.3%），而穿透性損傷較前明顯下降（18.2%vs. 33.7%）（χ²=28.9，P=0.000）。2012 年前后創傷部位中肋骨骨折（P=0.000）、肺挫傷（P=0.000）、氣胸（P=0.000）和胸腹聯合傷（P=0.001）均發生了明顯變化。結論 2012 年是我院 10 年期間胸部創傷類型及創傷部位發生明顯變化趨勢的重要時間截點，對我院下一步胸部創傷救治側重點轉變帶來了新的思考和考驗。

Citation： LI Aijian. Clinical analysis of 1 250 patients with thoracic injuries. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(5): 400-403. doi: 10.7507/1007-4848.201507052 Copy

1.	?Veysi VT, Nikolaou VS, Paliobeis C, et al. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop, 2009, 33(5): 1425-1433.
2.	Bowley DM, Degiannis E, Westaby S, Chief editor. Thoracic Injury. Ballistic Trauma. London: Springer. 2005. 241-269.
3.	Miller LA. Chest wall, lung, and pleural space trauma. Radiol Clin N Am, 2006, 44(2): 213-224.
4.	Serdar O, Refik U, Alper A, et al. Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center. Injury, 2011, 42(9): 900-904.
5.	張華, 陳君, 樊玉霞, 等. 嚴重胸部損傷合并顱腦損傷 92 例. 中華創傷雜志, 2013, 29(3): 271-272.
6.	Short RM, Crittenden M, Indeck M, et al. Blunt thoracic trauma: analysis of 515 patients, Ann Surg, 1987, 206(2): 200-205.
7.	Pollak S, Saukko P, Chief editor. Blunt Injury. Encyclopedia of Forensic Sciences. Second edtion. Poland: Elsevie. 2013. 1-10.
8.	Zreik NH, Francis I, Ray A, et al. Blunt chest trauma: bony injury in the thorax. Brit J Hosp Med, 2016, 77(2): 72-77.
9.	Welsford M, Pardhan A, Chief editor. Penetrating Trauma. Emergency Medical Services: Clinical Practice and Systems Oversight. Second Edition. John Chichester: Wiley & Sons, Ltd, 2015. 228-236.
10.	Wang T, Yin X, Zhang P, et al. Road traffic injury and rescue system in China. Lancet, 2015, 385: 1622.
11.	中華醫學會創傷學分會交通傷與創傷數據庫學組、創傷急救與多發傷學組. 嚴重胸部創傷救治規范. 中華創傷雜志, 2013, 29(5): 385-390.
12.	陳林, 向東生, 馬瓊英. 胸部外傷的影像學檢查及表現. 中華肺部疾病雜志: 電子版, 2015, 4: 103-104.
13.	?orbac?o?lu SK, Er E, Aslan S, et al. The significance of routine thoracic computed tomography in patients with blunt chest trauma. Injury, 2015, 46(5): 849-853.
14.	Kong VY, Sartorius B, Clarke DL. The accuracy of physical examination in identifying significant pathologies in penetrating thoracic trauma. Eur J Trauma Emerg Surg, 2014, 41(6): 647-650.
15.	Engel J. Management of pulmonary contusion and flail chest: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care, 2012, 73(5): S351-S361.
16.	高勁謀, 都定元, 劉朝普, 等. 伴多發傷連枷胸的損傷控制外科治療. 中華創傷雜志, 2013, 29(4): 343-347.
17.	劉伯夫, 王鑫, 車國衛, 等. 連枷胸合并肺挫傷研究進展. 中國胸心血管外科臨床雜志, 2015, 21(11): 1056-1059.
18.	Kong V, Oosthuizen G, Clarke D. Selective conservatism in the management of thoracic trauma remains appropriate in the 21st century. Ann Roy Coll Surg, 2015, 97(5): 224-228.
19.	霍承瑜, 劉宗志, 牛磊. 188 例胸腔穿透傷診療經驗. 中華胸心血管外科雜志, 2013, 29(2): 111-112.
20.	Mizushima Y, Nakao S, Watanabe H, et al. Thoracotomy for blunt chest trauma: is chest tube output a useful criterion? Acute Medicine & Surgery, 2015 Aug 12. [Epub ahead of print].

1. ?Veysi VT, Nikolaou VS, Paliobeis C, et al. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop, 2009, 33(5): 1425-1433.
2. Bowley DM, Degiannis E, Westaby S, Chief editor. Thoracic Injury. Ballistic Trauma. London: Springer. 2005. 241-269.
3. Miller LA. Chest wall, lung, and pleural space trauma. Radiol Clin N Am, 2006, 44(2): 213-224.
4. Serdar O, Refik U, Alper A, et al. Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center. Injury, 2011, 42(9): 900-904.
5. 張華, 陳君, 樊玉霞, 等. 嚴重胸部損傷合并顱腦損傷 92 例. 中華創傷雜志, 2013, 29(3): 271-272.
6. Short RM, Crittenden M, Indeck M, et al. Blunt thoracic trauma: analysis of 515 patients, Ann Surg, 1987, 206(2): 200-205.
7. Pollak S, Saukko P, Chief editor. Blunt Injury. Encyclopedia of Forensic Sciences. Second edtion. Poland: Elsevie. 2013. 1-10.
8. Zreik NH, Francis I, Ray A, et al. Blunt chest trauma: bony injury in the thorax. Brit J Hosp Med, 2016, 77(2): 72-77.
9. Welsford M, Pardhan A, Chief editor. Penetrating Trauma. Emergency Medical Services: Clinical Practice and Systems Oversight. Second Edition. John Chichester: Wiley & Sons, Ltd, 2015. 228-236.
10. Wang T, Yin X, Zhang P, et al. Road traffic injury and rescue system in China. Lancet, 2015, 385: 1622.
11. 中華醫學會創傷學分會交通傷與創傷數據庫學組、創傷急救與多發傷學組. 嚴重胸部創傷救治規范. 中華創傷雜志, 2013, 29(5): 385-390.
12. 陳林, 向東生, 馬瓊英. 胸部外傷的影像學檢查及表現. 中華肺部疾病雜志: 電子版, 2015, 4: 103-104.
13. ?orbac?o?lu SK, Er E, Aslan S, et al. The significance of routine thoracic computed tomography in patients with blunt chest trauma. Injury, 2015, 46(5): 849-853.
14. Kong VY, Sartorius B, Clarke DL. The accuracy of physical examination in identifying significant pathologies in penetrating thoracic trauma. Eur J Trauma Emerg Surg, 2014, 41(6): 647-650.
15. Engel J. Management of pulmonary contusion and flail chest: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care, 2012, 73(5): S351-S361.
16. 高勁謀, 都定元, 劉朝普, 等. 伴多發傷連枷胸的損傷控制外科治療. 中華創傷雜志, 2013, 29(4): 343-347.
17. 劉伯夫, 王鑫, 車國衛, 等. 連枷胸合并肺挫傷研究進展. 中國胸心血管外科臨床雜志, 2015, 21(11): 1056-1059.
18. Kong V, Oosthuizen G, Clarke D. Selective conservatism in the management of thoracic trauma remains appropriate in the 21st century. Ann Roy Coll Surg, 2015, 97(5): 224-228.
19. 霍承瑜, 劉宗志, 牛磊. 188 例胸腔穿透傷診療經驗. 中華胸心血管外科雜志, 2013, 29(2): 111-112.
20. Mizushima Y, Nakao S, Watanabe H, et al. Thoracotomy for blunt chest trauma: is chest tube output a useful criterion? Acute Medicine & Surgery, 2015 Aug 12. [Epub ahead of print].

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