胸部创伤中不同致伤机制导致气管破裂临床特征分析  

Analysis of 5 cases of tracheal rupture caused by different traumatic mechanisms and literature review

作　　者：钟仕利 伍正彬 陈春燕 陈浩 蒋东坡 Zhong Shili;Wu Zhengbin;Chen Chunyan;Chen Hao;Jiang Dongpo(Department of ICU,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院重症医学科,重庆400042

出　　处：《创伤外科杂志》2022年第9期696-700,704,共6页Journal of Traumatic Surgery

基　　金：重庆市临床重点专科项目基金资助。

摘　　要：目的探讨胸部创伤中不同致伤机制导致气管破裂的治疗方式对预后的影响。方法回顾性分析2016年9月—2021年9月陆军军医大学大坪医院重症医学科收治不同致伤原因导致气管破裂患者5例,男性3例,女性2例;年龄24~59岁,平均42.2岁。分析患者致伤机制、临床诊断、诊断方法、气管破裂部位及破口大小、治疗方法、并发症、ICU住院时间、预后等临床资料。结果5例创伤性气管破裂患者致伤原因为道路交通伤2例、重物砸伤1例、挤压伤1例、刀割伤1例;气管损伤部位及受损程度也不同,其中4例由纤维支气管镜检查确诊,1例肉眼可见刀割伤,通过手术明确气管破裂位置。5例中2例通过非手术治疗完全治愈,3例通过手术治疗后治愈。对5例患者出院3月内复查血气分析中的氧合指数进行随访,1例患者在第3个月时出现呼吸困难,入院后检查发现气管狭窄,予以气管扩张术后呼吸困难改善,1例患者在出院后2周时出现呼吸困难,入院后检查发现气管狭窄,其余3例患者氧合指数均得到显著改善。结论通过评估患者致伤原因、伤后状态及伤情决定是否手术治疗,手术及非手术治疗后密切随访患者是否发生并发症,及时干预治疗,以达治愈目的。Objective To investigate the effect of treatment of bronchial rupture caused by different traumatic mechanisms on prognosis.Methods Retrospective analysis was performed on 5 patients with tracheal rupture caused by trauma in Department of ICU,Daping Hospital,Army Medical University from Sep.2016 to Sep.2021,including 3 males and 2 females,aged from 24 to 59 years,mean 42.2 years. Clinical data including patient injury mechanism,clinical diagnosis,diagnostic method,tracheal rupture site and rupture size,treatment methods,complications,time of ICU stay,prognosis and other clinical data were retrospectively analyzed. Meanwhile,literatures related to tracheal rupture were reviewed to provide more clinical treatment experience for the clinical treatment of tracheal rupture.Results The five patients with traumatic duct rupture had different injury mechanisms.The injury mechanisms of the 5 patients with traumatic air duct rupture were different,including vehicle impact in 2 cases,heavy object injury in 1 case,extrusion in 1 case,knife cutting in 1 case,and the trachea injury site and degree were also different. Among them,4 patients with traumatic duct rupture were confirmed by fiberoptic bronchoscopy,and 1 case was cut by visible knife,and the location of trachea rupture was determined by operation. Of the 5 patients with traumatic duct rupture,2 cases were completely cured by conservative treatment and 3 cases were cured by surgery.The oxygenation index of blood gas analysis in 5 patients with traumatic duct rupture was followed up within 3 months after discharge,1 patient had difficulty breathing at 3 months,revealed tracheal stenosis after admission examination,and improved dyspnea after tracheal expansion;1 patient developed dyspnea 2 weeks after discharge,and revealed tracheal stenosis after admission examination;the oxygenation index of the remaining 3 patients was significantly improved.Conclusion Surgical treatment is decided by detailed assessment of injury mechanism,post-injury body state,tracheal rupture sit

关 键 词：胸部创伤 创伤性气管破裂 纤维支气管镜检查 气管狭窄 

分 类 号：R653[医药卫生—外科学]