创伤性肺内血肿与血气囊肿的处理规范  

Management standards for traumatic intrapulmonary hematoma and hematocele

作　　者：谭远康[1] 孔今文[1] 都定元[1] 赵兴吉[1] 苏泓洁[1] 张为民[1] 

机构地区：[1]重庆市急救医疗中心、重庆市急救医学研究所胸心外科,400014

出　　处：《中华创伤杂志》2012年第7期613-616,共4页Chinese Journal of Trauma

基　　金：重庆市科委自然科学基金重点资助项目（CSTC2012jjBI0021）,重庆市卫生局医学科学技术研究重申噗资助项目（2010-1-52;2011-2-378）

摘　　要：目的探讨创伤性肺内血肿或血气囊肿的处理规范。方法对我院1999年8月-2010年8月救治的21例创伤性肺内血肿或血气囊肿患者（MS≥14）资料进行回顾性分析。结果（1）全组病死率为14％（3／21），死因为呼吸道大出血窒息；（2）67％（14／21）伴有咯血症状，咯血时间为1-240d，平均15．8d，肺内血肿或血气囊肿咯血时间约为单纯肺气囊肿咯血时间的3．4倍；（3）肺内血肿或囊肿消失时间平均为61．6d，其中肺内血肿和血气囊肿消失时间为单纯肺气囊肿消失时间的3．4倍。（4）肺内血肿或血气囊肿大小及部位影响救治方式、救治结局及预后。结论规范创伤性肺内血肿或血气囊肿的治疗是提高救治成功率的关键，对直径〉6．0cm肺内血肿或血气囊肿以及肺气囊肿伴重度漏气呼吸不能维持者需及早行确定性手术。Objective To investigate the standards for management of traumatic intrapulmonary hematoma and hematoeele. Methods A retrospective study was conducted on the data of 21 patients with traumatic pulmonary hematoma or hematocele （AIS≥4 points ） treated at Chongqing Emergency Medical Center from August 1999 to August 2010. Results The overall mortality was 14% （3/21） and death causes were respiratory passage hemorrhea and asphyxia. About 67% of patients （ 14/21 ） were as- sociated with hemoptysis, which lasted for 1-240 days （mean, 15.8 days ）. The duration of hemoptysis due to traumatic intrapulmonary hematoma hematocele was about 3.4 times longer than that due to simple traumatic pneumatocele. The hematnma or cyst disappeared at average 61.6 days, with 3.4 times longer than the disappearance time of intrapulmonary hematoma or hematocele in comparison with that of simple pneumatocele. The size and position of traumatic pulmonary hematoma or pneumatocele influenced the treatment methods, outcomes and prognosis. Conclusions Standardized treatment for traumatic pulmo- nary hematoma or hematocele is key to improving the cure rate. Early emergency definitive surgery is re- quired for patients with traumatic intrapulmonary hematoma or hematocele greater than 6.0 cm in diameter and for those with pneumatocele greater than 6.0 cm in diameter combined with incapability of keeping breathing due to severe air leakage.

关 键 词：胸部损伤 肺 血肿 囊肿 手术/非手术处理 

分 类 号：R655[医药卫生—外科学]