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相關文獻
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- 胸部外傷
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- The Management of Chest Trauma--A 16 years' Experience
頁籤選單縮合
題名 | Management of Pneumohemothorax in the Chest Trauma=胸部外傷時血氣胸的處理 |
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作者 | 高英隆; 林永哲; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 13:2 1980.06[民69.06] |
頁次 | 頁111-118 |
關鍵詞 | 血氣胸; 胸部外傷; |
語文 | 英文(English) |
中文摘要 | 從民國62年元月到68年9月,高雄醫學院外科共經驗248例胸部外傷的病例;其中男性225例,女性23例;以25歲到45歲的青壯年期為主。 主要原因為交通事故(106例),銳器創傷(64例)及下墜,鈍挫(42例);而醫源性外傷則由於檢查,治療及中心靜脈導管放置的頻繁,見有24例之多。 特別就146例血胸氣胸的治療情形,報告如下: 1、單側的血胸或氣胸有45例,兩者合併者有47例,兩側同時發生者有54例。 診斷上,胸部X光可明確認出血胸氣胸的存在;但危急時,僅憑創傷病史,及理學檢查,可省略胸部X光攝影,而立刻給予有效的排氣或排液的處理。 2、治療上,對病情穩定及少量血氣胸的病例,以觀察(12例)或針刺抽液(10例),可得到改善。使用胸管排液的115例當中,對於氣胸使用24F-36F的矽管,由前胸第二三肋間置放;對於血胸則使用32F- 40F的矽管,由側壁第五六肋間置放。平均留存時間為3.72±2.45天。初次血胸引流量為370.59±327.84 ml。遇有胸管引流不順暢時,不宜反覆沖洗,應考慮重行置換胸管。 3、由胸管置放引發的合併症有皮下氣腫13例,肺損傷5例,肝損傷3例,橫隔穿通1例及膿胸3例,都經矯治後生存。 4、血胸引流速度超過3-5 ml/kg/hr時,應作開胸手術(3例);此外如肺實質損傷(11例),食道穿破(2例)橫隔裂傷(5例),異物貯留(2例)及心臟損傷(2例)都必須作手術治療;對於11例纖維化血胸或膿胸,均以開胸作剝皮術治療,手術後並應注意肺再膨脹後之水腫。36例開胸手術中,有2例死亡,手術死亡率為5.5%。 我們經驗的248例胸部外傷中,66%合併有頭部、腹部等其他外傷,而成為死亡之主要原因。總共有25例死亡,其中14例被發現有血胸或氣胸的存在,死亡率為10.0%。 |
英文摘要 | One hundred and fourty six patients with either pneumothorax or hemothorax in a senes of 248 acute chest trauma mainly following automobile accident were almostly (78.7 per cent) treated by means of lntercostal tube thoracostomy. In the dependent drainage site, 32F-40F siliconized catheter for hemothorax and 24F-36F catheter for pneumothorax were used repectively. The average duration of chest drainage was 3.72±2.45 days and the average initial drainage volume of hemothorax was 370.59±327.84 ml. Thoracotomy was performed in 36 cases when satisfactory evacuation of pneumohemothorax could not be accomplished, such as massive hemorrhage, lung parenchyma injury, diaphragmatic rupture and clotted hemothorax. Causes of death were chiefly due to the multiplicity and complexity of extrathoracic associated injuries, especially the head injury. There were 10 per cent of mortality and 2 cases died after thoracotomy giving operative mortality 5.5 per cent. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。