钝伤性纵隔气肿的深层认识及应对策略探讨  

Further understanding and clinical strategies of blunt traumatic pneumomediastinum

作　　者：霍承瑜[1] 牛磊[1] 刘宗志[1] 肖琳[1] 

机构地区：[1]民航总医院胸外科,北京100123

出　　处：《中国现代医学杂志》2014年第7期95-98,共4页China Journal of Modern Medicine

摘　　要：目的探讨钝伤性纵隔气肿的伤情特点及临床应对策略。方法回顾分析2002年10月-2012年10月收治的钝伤性纵隔气肿患者临床资料,加以分析总结。结果全组共29例,开胸手术17例,术后拔除胸管时间平均6.2 d,非开胸12例;29例中,治愈27例,死亡2例。结论钝伤性纵隔气肿往往提示暴力大,复合伤几率高,应引起重视。合并危及生命损伤应积极处理;无症状或症状轻微的纵隔气肿可观察病情而不必常规程序化有创检查;合并严重肺挫伤机械通气患者应注意迟发性血气胸甚至张力性气胸可能;合并肋骨骨折患者可考虑早期手术治疗;意识障碍病人胸部手术后对于呼吸管理的要求高,临床应引起警惕。[Objective] To explore the injury features of blunt traumatic pneumomediastinum and treatment strategies. [Methods] The retrospective data for blunt traumatic pneumomediastinum from October 2002 to October 2012 were reviewed. [Results ] A total of 29, 17 cases received thoracic surgery with an average of 6.2 days removing chest tube, 12 cases received non-thoracotomy. Of all cases, 27 were cured, 2 were dead. [Conclusion] Blunt traumatic pneumomediastinum is usually caused by strong force and likely to be accompanied with other injuries. Blunt traumatic pneumomediastinum with life-threatening pneumomediastinum should be solved positively, and with asymptomatic and mild symptomatic pneumomediastinum should be put into active surveillance instead of routine invasive procedure. Those with severe pulmonary contusion and mechanical ventilatiou may lead to late-onset hemopneumothorax and tension hemopneumothorax. Those with rib fracture can receive early operation, and distur- bance of consciousness need the high level ventilation management.

关 键 词：纵隔气肿 肺挫伤 迟发性血气胸 张力性气胸 

分 类 号：R564.3[医药卫生—呼吸系统]