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| 題 名 | Delayed Recognition of Hemothorax and Hemopneumothorax in Blunt Chest Injury=挫傷引起之遲發血胸及血氣胸 |
|---|---|
| 作 者 | 吳明和; | 書刊名 | 中華民國外科醫學會雜誌 |
| 卷 期 | 21:5 1988.09[民77.09] |
| 頁 次 | 頁604-609 |
| 分類號 | 416.22 |
| 關鍵詞 | 挫傷; 遲發血胸; 血氣胸; |
| 語 文 | 英文(English) |
| 中文摘要 | 胸部挫傷所引起之血胸或血氣胸,根據外傷病史,理學檢查,加上胸部X光檢查,大多數病人住院前在急診室已得到診斷。然而少數挫傷病人,在初期胸部X光檢查並來顯示血胸或血氣胸。經過數小時或數日,由於病情變化,胸部X光再次檢查,才顯示出來,或者因合併之腹部受傷,在行剖腹術時而發現橫隔膜異常鼓出及變色,才發現血胸或血氣胸。其發生原因可歸額如下:一、早期之肋膜腔出血少於300 c.c. -500 c.c.,而後漸漸增加。二、延遲發生之出血或漏氣。三、肋膜外之血腫破裂至肋膜腔。四、初期胸部X光無法明示肺下緣之肋膜腔積血。五、後腹腔出血而逐漸向上延伸至肋膜腔。 亞東紀念醫院自1983年1月至1987年11月,近五年內有278例因胸部挫傷住院,其中血胸26例,12例初期胸部X光未顯示血胸;血氣胸28例,6例初期胸部X光未顯示血氣胸,經數小時或數日後,胸部X光再次檢查或腹部手術時發現有血胸或血氣胸者佔35% (18/54),其比例之高,出乎意料之外。另有一例僅因骨盤及下腹受車輛輾撞,6天後後腹腔之血腫延伸至兩側肋膜腔而成血胸,比例未包括在內。18例胸部挫傷併有遲發性血胸或血氣胸的病人,其中16例除肋骨骨折外,合併其他器官之傷害,如頭部外傷,脾臟破裂,肝裂傷,橫隔膜破裂,心包膜破裂,長骨骨折。其中兩例死於腦部出血,餘存活。 胸部挫傷可造成遲發性血胸或血氣胸,在本院約佔6.5%(18/278)。病人如神智清醒,可主訴胸痛、胸悶、呼吸困難。但是神智不清的病人,血壓下降,脈博增快,心跳加速,呼吸急促,不可以為初期胸部X光未見血胸或血氣胸就認為正常。需要再次的胸部X光檢查方有助於遲發性血胸及血氣胸之發現。 |
| 英文摘要 | Two hundred and seventy eight cases of blunt chest injury were admitted to the Far Eastern Memorial Hospital during a 5-year period. We found that in 18 of 278 patients (6.5%) the initial chest films taken in the emergency room were negative for hemothorax or hemopneumothorax which subsquently developed a few days later. In 12 of 26 hemothoraces (46%) and 6 of 28 hemopneumothoraces (21.4%) the occurence was delayed. The possible causes of delayed recognition are: (1) early bleeding in the pleural cavity less than 300-500c.c. and small air leak, these increased progressively, (2) delayed onset of bleeding, (3) extrapleural hematoma rupturing into the pleural cavity, (4) initial chest film not detecting the subpulmonary hematoma, (5) retroperitoneal hematoma progressively extended up to the pleural cavity. |
本系統中英文摘要資訊取自各篇刊載內容。