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

成都大学附属医院心胸外科（成都 610081）;

Corresponding author：

金健, Email: 577266594@qq.com

Keywords：

胸部损伤; 创伤中心; 回顾性研究

DOI：

10.7507/1007-4848.201507052

Video：

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目的总结胸部创伤流行病学及临床特征，为创伤的预防和救治提供科学依据。方法回顾性分析 2005～2015 年我院胸心外科连续收治 1 250 例胸部创伤患者的临床资料。根据患者伤情，分别采用无创性保守治疗、胸腔闭式引流术、开胸探查止血术、肋骨内固定术及其他胸部及心脏创伤的修补术。观察创伤患者致伤类型、创伤部位、治疗方式与临床预后以及 2012 年前后时间分布及其相关性。结果全组男 999 例（79.9%）、女 251 例（20.1%），平均年龄（44.0±17.7）岁。非穿透性损伤 885 例（70.8%），穿透性损伤 365 例（29.2%），死亡 8 例（0.64%）。肋骨骨折 766 例，骨折内固定手术干预占 16.1%（123/766），手术复位内固定患者平均住院时间明显短于保守治疗患者（9.55 dvs. 16.38 d，t=6.574，P=0.000）。2012 年后非穿透性损伤较 2012 年前有所升高（81.8%vs. 66.3%），而穿透性损伤较前明显下降（18.2%vs. 33.7%）（χ²=28.9，P=0.000）。2012 年前后创伤部位中肋骨骨折（P=0.000）、肺挫伤（P=0.000）、气胸（P=0.000）和胸腹联合伤（P=0.001）均发生了明显变化。结论 2012 年是我院 10 年期间胸部创伤类型及创伤部位发生明显变化趋势的重要时间截点，对我院下一步胸部创伤救治侧重点转变带来了新的思考和考验。

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

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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.	张华, 陈君, 樊玉霞, 等. 严重胸部损伤合并颅脑损伤 92 例. 中华创伤杂志, 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.	中华医学会创伤学分会交通伤与创伤数据库学组、创伤急救与多发伤学组. 严重胸部创伤救治规范. 中华创伤杂志, 2013, 29(5): 385-390.
12.	陈林, 向东生, 马琼英. 胸部外伤的影像学检查及表现. 中华肺部疾病杂志: 电子版, 2015, 4: 103-104.
13.	Çorbacıoğlu 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.	高劲谋, 都定元, 刘朝普, 等. 伴多发伤连枷胸的损伤控制外科治疗. 中华创伤杂志, 2013, 29(4): 343-347.
17.	刘伯夫, 王鑫, 车国卫, 等. 连枷胸合并肺挫伤研究进展. 中国胸心血管外科临床杂志, 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, 刘宗志, 牛磊. 188 例胸腔穿透伤诊疗经验. 中华胸心血管外科杂志, 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. 张华, 陈君, 樊玉霞, 等. 严重胸部损伤合并颅脑损伤 92 例. 中华创伤杂志, 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. 中华医学会创伤学分会交通伤与创伤数据库学组、创伤急救与多发伤学组. 严重胸部创伤救治规范. 中华创伤杂志, 2013, 29(5): 385-390.
12. 陈林, 向东生, 马琼英. 胸部外伤的影像学检查及表现. 中华肺部疾病杂志: 电子版, 2015, 4: 103-104.
13. Çorbacıoğlu 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. 高劲谋, 都定元, 刘朝普, 等. 伴多发伤连枷胸的损伤控制外科治疗. 中华创伤杂志, 2013, 29(4): 343-347.
17. 刘伯夫, 王鑫, 车国卫, 等. 连枷胸合并肺挫伤研究进展. 中国胸心血管外科临床杂志, 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, 刘宗志, 牛磊. 188 例胸腔穿透伤诊疗经验. 中华胸心血管外科杂志, 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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