頁籤選單縮合
題名 | Traumatic Airway injuries Emphasize on The Principles of Initial Management=外傷性氣道創傷--初期處置原則之強調 |
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作者 | 徐中平; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 25:4 民81.07-08 |
頁次 | 頁1253-1260 |
分類號 | 416.215 |
關鍵詞 | 外傷性氣道創傷; |
語文 | 英文(English) |
中文摘要 | 外傷性氣道創傷並不常見。常見的臨床症狀及徵兆包括呼吸困難、皮下氣腫、縱隔氣腫、及氣胸等。早期的診斷及適時的修補為治療此類病患的要件。延誤治療及氣道以外之併存傷害是造成病患死亡的主因。 近八年多來,台中榮總胸腔外科有17例氣道創傷的處置經驗。這些病患的致傷原因多由自殺及車禍引起。這17例病患中,有13例在24小時內於本院接受最初的處置,其併發症及死亡率分別為23.1%及15.4%,另外四例先在其他醫院接受處置後因病況惡化而於受傷24小時後再轉送本院處置,其併發症及死亡率分別為75%及25%。上呼吸道創傷有12例,其併發症及死亡率分別為41.7%及8.3%,下呼吸道創傷有五例,其併發症及死亡率分別為20%及40%。 根據本院分析處置這些病人的經驗及結果,吾等認為這些病人初期處置之原則包括:1.立刻維持氣道之暢通,2.防止氣道之異物吸入,3.維持循環系統之穩定,4.氣胸之減壓,5.迅速找出氣道受創的位置,6.及時治療氣道以外之合併創傷,7.迅速修護受創之氣道。 |
英文摘要 | The clinical manifestations of airway trauma include dyspnea, hemoptysis, subcutaneous emphysema, mediastinal emphysema, and pneumothorax. We had 17 cases experience of laryngotracheobronchial injury in the past 8 years, and all of our patients had all or part of the above clinical manifestations. Most of these injuries were caused by suicide attempt or traffic accident. The diagnosis can be made by physical examination, chest X-ray examination, and bronchoscopy. Thirteen victims received initial aid in our hospital within 24 hours (Group I). The remaining 4 victims had clinical delay over 24 hours (Group II). The complication and mortality rates in the Group I patients were 23.1% and 15.4%, while those of the Group II patients were 75% and 25%. The complication and mortality rates of extrathoracic airway injuries (proximal to thoracic inlet) were 41.7 and 8.3%, while those of intrathoracic airway injuries (below thoracic inlet) were 20% and 40%. The clinical delay in diagnosis and concomitant injuries were the major causes of death. Upper airway injuries had the higher complication rate, while lower airway injuries had the higher mortality rate. According to our experience, the management of such patients should be based on the following principles: 1. immediate airway maintenance, 2. prevention of aspiration, 3. restoration of cardiovascular stability, 4. decompression of pneumothorax, 5. rapid localization of the site of injury, 6. treatment of concomitant injuries, and 7. repair of airway as soon as possible. |
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