275例老年胸部损伤后急性呼吸功能不全危险因素分析和治疗  

Risk factors analysis and treatment of elder chest trauma patients associated with acute respiratory disfunction in 275 cases

作　　者：许月明[1] 陈虎平[1] 游波[1] 

机构地区：[1]解放军第三二四医院心胸外科,重庆400020

出　　处：《重庆医学》2010年第15期2005-2006,2008,共3页Chongqing medicine

摘　　要：目的探讨老年胸部损伤后急性呼吸功能不全的危险因素及救治对策。方法对1995年9月至2008年6月收治的275例生存超过24h的60岁以上胸部损伤患者发生呼吸功能不全的危险因素进行回顾性分析,包括肋骨骨折数、创伤严重程度评分(ISS)分值、肺挫伤、休克、合并伤、合并慢性病、抢救治疗过程等。结果发生急性呼吸功能不全22例(8.00%),多器官功能不全16例(5.82%)。肋骨骨折数大于或等于4根、ISS≥25、合并颅脑损伤者意识状态评分(GCS)≤8分、休克重且持续时间大于或等于4h、肺挫裂伤超过2叶、合并慢性阻塞性肺疾病、糖尿病、肥胖等是胸部损伤后呼吸功能不全的高危因素。结论抢救早期应高度重视呼吸保护等综合救治措施。Objective To approach the severity adverse facters and save methods after chest trauma in elders. Methods This was a retrospective study on severity adverse factors for respiratory disfunetion by examining 275 patients ≥60 years old with chest trauma, surviving greater than 24 hours from Sepertember 1995 to June 2008. Outcomes variables included the number of rib frac- t ures, Injury Severity Score （ ISS）, shock, pulmonary contusion, associated injuries, affiliate chronic disease, treatment process and so on. Results 22 aggravated to acute respiratory insufficency （incidence 8.00% ）, 16 multiple organ disfunction syndrome （incidence 5.82% ）. Patients over the age of 60 with more than four rib fractures, ISS≥25,GCS≤8, severily shock and time persistence ≥4 hours,lung contusion over 2 fields,and affiliated COPD,diabetes mellitus,obesitas were at increased risk of adverse outcomes for acute respiratory disfunction after chest trauma. Conclusion Pay attention to respiratory conservation early is very important for comprehensive rescue.

关 键 词：胸部损伤 老年人 呼吸功能不全 危险因素 

分 类 号：R655[医药卫生—外科学] R563.8[医药卫生—临床医学]