摘要
目的探讨爆震伤所致胸部创伤的临床特征和救治方法,提高对胸部爆震伤的认识及处理能力。方法回顾性分析解放军第一七五医院2000年1月—2016年12月收治的65例胸部爆震伤患者的临床资料,男性42例,女性23例;年龄18~55岁,平均42.6岁;致伤原因:化工厂爆震伤16例,锅炉爆震伤11例,煤气罐爆震伤23例,粉尘爆震伤5例,地下矿井爆震伤10例。血气胸22例,心包积液3例,纵隔血肿15例,肋骨骨折28例;合并烧伤46例,复合肺吸入性损伤38例,腹部脏器损伤12例,颅脑损伤5例。对胸部损伤情况、影像学资料、治疗措施及预后情况等进行分析。结果 13例患者入院时神志模糊、52例神志清楚,受伤至入院时间为(3.16±0.78)h,其中42例出现咳嗽、咯血等症状。胸部X线(或)CT检查结果显示:毛玻璃样改变7例,肺段或肺叶性实变23例,弥漫性实变35例。胸腔闭式引流术15例,开胸止血8例,肺叶修补6例,肺叶切除术3例,膈疝修补4例,胸部巨大缺损重建5例,开胸探查并内固定胸壁12例,气管、支气管断裂修复2例,胸腹联合探查7例。21例并发肺部感染,32例发生休克;死亡3例,存活62例,存活患者随访6个月无死亡病例。结论胸部爆震伤外轻内重,复合伤及并发症多,伤情复杂,临床救治难度较大,及时、有效地维持呼吸、循环功能稳定在胸部爆震伤救治中具有重要作用。
Objective To investigate the clinical features and treatment methods of chest injury caused by blast injury,and to improve the understanding and treatment capacity of chest blast injury. Methods Retrospective analysis was performed on the clinical data of 65 patients with chest-detonation injuries who were admitted to the175 th PLA Hospital from Jan. 2000 to Dec. 2016. There were 42 males and 23 females,with an average age of 42. 6 years（ range,18-55 years）. Causes of injuries included： 16 cases of chemical blast injury,11 cases of boiler blast injury,23 cases of gas tank blast injury,5 cases of dust explosion blasting,and 10 cases of underground mine blast injury. There were 22 cases of blood pneumothorax,3 cases of pericardial effusion,15 cases of mediastinal hematoma,and 28 cases of rib fracture. Forty-six patients had burns,38 had compound lung inhalation injury,12 had abdominal organ injuries and 5 had brain injury. Thoracic damage,imaging data,treatment and prognosis were analyzed. Results Thirteen patients were ambiguous at the time of admission and 52 were conscious. The time from injury to admission was（ 3. 16 ± 0. 78） hours,and 42 cases had symptoms such as cough and hemoptysis. Chest X-ray and（ or） CT examination results showed that there were 7 cases of ground glass change,23 cases of consolidation of lung or lung lobe,and 35 cases of diffuse consolidation. Closed thoracic drainage was conducted in 15 cases,chest thoracotomy in 8 cases,pulmonary leaf repair in 6 cases,lobectomy in 3 cases,hernia repair in 4 cases,chest reconstruction in 5 cases,open chest exploration and internal fixation of the chest wall in 12 cases,trachea and bronchus repair in2 cases and joint thoracoabdominal exploration in 7 cases. Twenty-one patients had concurrent pulmonary infections and 32 patients experienced shock. Three patients died and 62 patients survived. There was no death in patients who survived after 6 months of follow-up. Conclusion Thoracic blast injury has complex injuries and complications,and difficult clinical treatment. It can maintain respiratory and circulatory function stability by a timely and effective manner and can effectively control and reduce the extent of chest blast injury and improve the success rate of treatment.
作者
陈松林
易云峰
陈检明
钟京
焦昌结
郭军华
CHEN Song-lin;YI Yun-feng;CHEN Jian-ming;ZHONG Jing;JIAO Chang-fie;GUO Jun-hua(Department of Cardiothoracic Surgery,the 175th Hospital of PLA,Southeast Hospital Affiliated to Xiamen University,Zhangzhou,Fujian 363000,China)
出处
《创伤外科杂志》
2018年第7期495-498,506,共5页
Journal of Traumatic Surgery
基金
全军后勤科研项目(CNJ14C007
CWH17J030)
关键词
胸部创伤
爆震伤
临床特点
治疗
thoracic trauma
blast injuries
clinical features
treatment
作者简介
通信作者：易云峰，E-mail：Yyfeng．dor1969@163．com
