紧急剖胸术在严重胸部创伤中的应用价值及手术指征探讨.pdfVIP

《现代仪器与医疗》 2017年  第23卷   第2期 临床研究 紧急剖胸术在严重胸部创伤中的应用价值 及手术指征探讨 刘宗志　霍承瑜　牛磊 （民航总医院心胸外科，北京　100123 ） [ 摘　要 ]　目的 ：分析紧急剖胸术（Emergency thoracotomy ，ET ）在严重胸部创伤中的应用价值，探讨其手术 指征。方法 ：分析行ET 的120 例严重胸部创伤患者资料，将接受急诊室ET 的42 例患者纳入急诊室组，将接 受手术室ET 的78 例患者纳入手术室组。比较两组患者手术情况及预后，总结ET 的临床价值及手术指征。结 果 ：急诊室组ISS 评分、术后死亡率高于手术室组，差异有统计学意义（ ＜0.05 ）；穿透伤患者死亡率组间比 P 较，差异无统计学意义（ ＞0.05 ）。急诊室组存活患者术后并发症发生率为39.13% ，与手术室组的41.38% 比 P 较，差异无统计学意义（ ＞0.05 ）。随访期间4 例患者（均接受全肺切除）遗留中度肺功能障碍、右心功能不 P 全，11 例患者遗留轻度肺功能障碍，2 例患者心电图复查可见心肌损害表现，其余64 例患者均未见明显异常。 结论 ：急诊室ET 对钝性伤所致严重胸部创伤的治疗价值有限；严重胸部创伤患者ET 术后死亡原因以严重心包 压塞、失血性休克为主，对于符合上述手术指征或合并主要支气管损伤、空气栓塞者，应及时实施ET 。 [ 关键词 ]　紧急剖胸术；胸部创伤；手术指征 中图分类号：R655 文献标识码：A 文章编号：2095-5200(2017)04-021-03 DOI：10.11876/mimt201704009 Application value and surgical indications of emergency thoracotomy in severe thoracic trauma　LIU Zongzhi,HUo Chengyu,NIU Lei. Department of thoracicsurgery,Civil Aviation General Hospital,Beijing （ 100123 China ） [Abstract]　Objective: This study was designed to analyse the application value of emergency thoracotomy (ET) in severe thoracic trauma, and to explore its indications of operation. Methods: A total sample of 120 patients with severe thoracic trauma were analyzed. 42 patients who received ET of emergency department were included in the emergency room group, and 78 patients who received ET of operating room were included in the operating room group. The surgical conditions and prognosis of the two groups were compared, and the clinical value of ET and surgical indications were summed up. Results: The ISS score and postoperative mortality in the emergency room group were higher than those in the operating room group, the difference was statistic