创伤性肺不张68例临床诊治分析  

Diagnosis and treatment of traumatic atelectasis in 68 cases

作　　者：赵山红[1] 高劲谋[1] 胡平[1] 项震[1] 

机构地区：[1]重庆市急救医疗中心创伤科,400014

出　　处：《重庆医学》2013年第23期2733-2734,2739,共3页Chongqing medicine

摘　　要：目的探讨创伤性肺不张的早期诊断和治疗方法。方法回顾性分析2005年10月至2012年8月收治的68例创伤性肺不张病例的临床资料。结果 68例占同期胸外伤的4.22%。钝性伤64例,穿透伤4例。肺不张原因:肺挫伤51例(合并连枷胸16例),支气管破裂17例。发生于非手术治疗胸部伤49例,发生于剖胸术前4例,术中4例,术后11例。获诊方法:术中4例,影像学检查和纤支镜检64例。全肺切除1例,肺叶即肺段切除7例,支气管吻合6例,肋骨悬吊牵引8例,肋骨内固定(Jucet架)11例次,呼吸机辅助治疗12例。死亡率5.9%(4/68),死因为失血性休克1例,严重颅脑伤1例,术后MODS 1例,肺部严重感染致ARDS 1例。存活者中并发症23例:肺部感染16例,顽固性肺不张3例,限局性肺不张2例,ARDS 2例,均治愈。结论早期应反复影像学检查避免漏诊;支气管损伤的诊断,高质量CT优于纤支镜检;连枷胸早期正确的固定可降低该病发生率;叶以下支气管损伤建议行切除而非吻合术。Objective To discuss the early diagnosis and treatment of Traumatic atelectasis.Methods The data of 68cases with Traumatic atelectasis from October.2005to August.2012was analyzed retrospectively.Results Sixty-eight（4.22%）patients had atelectasis.Blunt injury in 64,penetrating injury in 4.The reasons of atelectasis：pulmonary contusion in 51,combined with flail chest in 16;bronchial disrupture in 17.Atelectasis occurred during the nonoperative treatment in 49patients,preoperatively in 4,intraoperatively in 4and postoperatively in 11.diagnosis method：4cases were diagnosed by thoracotomy,64cases were diagnosed by radiography and fibroptic bronchoscopy.pneumonectomy in 1,lobectomy in 7,bronchial anastomosis in 6,Suspended traction of ribs in 8,internal fixation of ribs（Jucet cage）in 11case-times,respirator treatment 12.The mortality rate was 5.9%（4/68）,1case died of associated severe cardiac and large blood vessel injuries,1case died of Craniocerebral injury,1case died of MODS and 1case died of ARDS following severe pulmonary infection.Complication in 23：pulmonary infection in 16,intractable atelectasis in 3,Limitations atelectasis in 2,ARDS in 2,all of them were cured.Conclusion Repeated Radiographic examination should be taken to avoid misdiagnosis;The diagnosis for bronchial disrupture,High quality CT is better than fibroptic bronchoscopy;For flail chest,Early correct fixtion can reduce the incidence of the atelectasis;To lobe bronchial disrupture,lobectomy is a wise policy.

关 键 词：肺不张 创伤和损伤 肺挫伤 支气管破裂 

分 类 号：R655.3[医药卫生—外科学]