46例钝性与穿透性膈肌损伤的临床比较研究  

Comparative study of blunt and penetrating diaphragm injuries in 46 patients

作　　者：武忠[1] 石应康[1] 杨建[1] 万亚红[1] 方强[1] 

机构地区：[1]成都华西医科大学附属第一医院胸心外科，成都 610041

出　　处：《中华创伤杂志》2001年第1期32-34,共3页Chinese Journal of Trauma

基　　金：卫生部科研基金资助项目(98-1-227)

摘　　要：目的　分析比较钝性与穿透性膈肌损伤的临床特点和伤情 ,以指导创伤的救治。　方法　 46例胸外伤合并膈肌破裂病人分为穿透伤组和钝性伤组 ,比较两组的损伤情况 ,并应用创伤评分系统进行创伤严重度评估。　结果　钝性胸外伤造成膈肌破裂的发生率低 ,复杂 ,常合并全身多发伤 ,但伤情进展相对较慢 ;穿透性胸外伤造成膈肌破裂的发生率高 ,伤情进展迅速 ,早期易出现失血性休克。比较损伤严重度评分 (ISS)、修正创伤评分 (RTS)和胸部简明损伤定级 (AIS) ,两组间差异无统计学意义 (P >0 .0 5 ) ,但钝性伤组入院时格拉斯哥昏迷指数 (GCS)和腹部AIS较低 ,分别为 12 .6 9± 2 .6 9,1.6 2± 1.6 6 (P <0 .0 5 )。　结论　针对钝性与穿透性膈肌损伤的不同临床特点 ,应采取相应的治疗措施 ,减少并发症 。Objective To compare the clinical characteristics and severity of blunt and penetrating diaphragm injuries so as to guide the diagnosis and treatment of trauma. Methods A total of 46 patients with chest trauma complicated by diaphragm ruptures were divided into two groups, the blunt injury group and the penetrating injury group. The injury conditions of the two groups were studied comparatively. In addition, the trauma severity of the two groups were evaluated by trauma score systems. Results The incidence of blunt diaphragm injuries was lower than that of penetrating injuries. Blunt injuries were usually complicated by multiple traumas, but with slow injury advance, while penetrating injuries developed more quickly, and hemorrhagic shock occurred easily in the early period. Trauma scores showed that there was no significant difference in revised trauma score (RTS), injury severity score (ISS) and thoracic Abbreviated Injury Scale (AIS) between the two groups ( P > 0.05 ), but the patients in the blunt injury group had lower Glasgow Coma Scale (GCS) and abdominal AIS ( P < 0.05 ). Conclusions Blunt and penetrating diaphragm injuries have different clinical characteristics. So it is necessary to take different measurements to reduce the complications and improve the prognosis.

关 键 词：胸部损伤 钝性 穿透性 膈肌损伤 比较研究 

分 类 号：R655.6[医药卫生—外科学]