影响胸部钝伤患者治疗方式临床因素分析  

Impact of Blunt Chest Trauma Treatment in Patients with Clinical Factors

作　　者：宋蕾 刘英勋 于帮旭[2] 张建国 

机构地区：[1]青岛市城阳区人民医院,266109 [2]青岛大学医学院附属医院ICU

出　　处：《青岛医药卫生》2007年第6期406-410,共5页Qingdao Medical Journal

摘　　要：目的探讨影响胸部钝伤住院患者治疗方式的因素,对胸部X片判读的差异进行分析,作为改进处置胸部钝伤患者的依据及参考。方法采用回顾性研究方法,收集2004年1月至2006年12月因胸部钝伤或其外伤合并胸部钝伤,经急诊评估损伤严重指数(ISS)≤15,且对胸部钝伤暂取保守疗法的住院患者共96例(男性76例,女性20例)。对患者年龄、过去病史、ISS、胸部X片判读等对治疗方式的影响与关系,分为因病情需要改取手术治疗组和继续采用保守治疗组来比较分析。结果两组在平均年龄、性別、ISS的统计上无差別。影响患者住院期间采用手术治疗的因素有年龄大于65岁(OR3.14,95%CI1.21-8.12,P<0.05);过去有心肺疾病病史(OR2.85,95%CI1.24-6.52,P<0.05);第一次的胸部X片判读有血胸(OR3.97,95%CI1.43-10.98,P=0.015)。结论年龄大于65岁、有心肺病史、第一次的胸部X片判读有血胸是胸部钝伤患者在住院后改取手术治疗的危险因子。有必要住院后追踪胸部X片。Objective To identify the factors and chest X-ray findings influencing the treatment option for blunt chest trauma patients with Injury Severity Score （ISS） ≤15 during admission who received initially conservative medical treatment. Methods Medical records and chest X-rays of 96 blunt chest trauma patients were reviewed retrospectively, 76 were male and 20 female who received conservative medical treatment initially with Injury Severity Score （ ISS ）≤15 from January, 2004 to December, 2006.44 patients received invasive surgical treatment and 52 patients received conservative medical treatment after admission. Demographic characteristics, underlying cardio-pulmonary disease, clinical manifestations, ISS, chest X-ray findings and treatment options were evaluated and compared between the two groups. Results The two groups had similar mean age （56.3 vs 48.5）, mean ISS （6.82 vs 5.77） and mean number of rib fractures （1.82 vs 2.42）. In elderly patients （265 years old）, this occurred in 36.4% of surgical group patients versus 15.3% of medical group patients （OR 3.14,95% CI 1. 21-8. 12,P〈0.05） and frequency of underlying cardio-pulmonary disease was 65.9 % for the surgical group versus 38.2 % for the medical group （OR 2.85,95% CI 1.24-6.52, P〈0.05） . Initial chest X-ray with hemothorax was found 34.1% and 11.5% in surgical and medical groups respectively （OR 3.97,95% CI 1.43-10.98,P=0. 015）. Serial chest X-rays performed after admission given a significant increase and higher diagnostic yield of pulmonary complications. Conclusion Elderly patients （965 years old）, with underlying cardio-pulmonary disease and an initial chest X-ray with hemothorax were significantly higher in frequency in the surgical group than the medical group （P〈0.05）. Following up chest X-ray is indicated during hospitalization.

关 键 词：胸部钝伤 损伤严重指数 胸部X片 

分 类 号：R655[医药卫生—外科学]