穿透性胸腹联合伤与胸腹多发伤的比较研究  

Comparative study of penetrating thoracoabdominal combined injuries and thoracoabdominal multiple injuries

作　　者：梁贵友[1] 石应康[1] 杨建[1] 张尔永[1] 

机构地区：[1]四川大学华西医院胸心外科,成都610041

出　　处：《中华创伤杂志》2003年第6期362-364,共3页Chinese Journal of Trauma

基　　金：卫生部科学研究基金资助项目 ( 98-1-2 2 7)

摘　　要：目的　比较穿透性胸腹联合伤 (TACI)和胸腹多发伤 (TAMI)的临床特点和伤情 ,以指导创伤的救治。　方法　 2 5 1例穿透性胸腹腔脏器同时损伤的患者 ,根据膈肌是否损伤 ,分为TACI组和TAMI组 ,比较两组的损伤情况和临床特点 ,并应用创伤评分系统进行创伤严重度评估。　结果　TACI 177例 ,TAMI 74例。TACI和TAMI的院前时间 (T1)、入院时修订创伤计分 (RTS1)分别为(1.86± 2 .2 7)h、6 .4 5± 1.6 4和 2 .81± 3.98h、6 .97± 1.18(P <0 .0 5 ) ;手术麻醉时修订创伤计分(RTS2 )、器官穿透伤指数 (PTI)则分别为 4 .90± 2 .4 2、2 2 .30± 9.72和 7.2 3± 0 .95、17.5 5± 6 .95 ) (P<0 .0 1) ;而两组的损伤严重度评分 (ISS)差异无显著性意义 (P >0 .0 5 )。TACI易累及心脏、大血管和肝脾等重要脏器 ,伤势重 ,伤情进展快。全组死亡 18例 ,总死亡率为 7.2 % ,而TACI的死亡率为9.0 % (16 177) ,明显高于TAMI组 (2 .7% ,2 74 ) (P <0 .0 5 )。　结论　TACI和TAMI在临床进程、伤情轻重及治疗结果等方面都有明显的差别。采用生理评分RTS与解剖评分PTI评估TACI和TAMI的创伤严重度较为可靠。正确选择手术入路和受损器官处理先后顺序能提高抢救成功率。Objective To compare the clinical features and severity of penetrating thoracoabdominal combined injuries (TACI) and thoracoabdominal multiple injuries (TAMI) so as to guide the diagnosis and management of trauma. Methods A total of 251 cases of penetrating chest trauma complicated by abdominal trauma were reviewed and divided into 2 groups. Group TACI (177 cases) was associated with diaphragmatic rupture but Group TAMI (74 cases) not. The injury features and the clinical characteristics of both groups were analyzed and the trauma severity of 2 groups evaluated by trauma score system. Results The pre-hospital time and the revised trauma score (RTS1) on admission were (1.86±2.27) hours and 6.45±1.64 respectively in the Group TACI, and (2.81±3.98) hours and 6.97±1.18 respectively in the Group TAMI ( P <0.05). The RTS at anaesthesia (RTS2) and the penetrating trauma index (PTI) were 4.90±2.42 and 22.30 ±9.72 respectively in the Group TACI, and 7.23±0.95 and 17.55±6.95 respectively in the Group TAMI ( P <0.01). There was no significant difference in injury severity scale (ISS) between both groups ( P > 0.05 ). TACI was easily complicated by injuries of vital organs such as the heart, the thoracic or the abdominal great vessel, the liver and the spleen. TACI was usually very serious and developed quickly. The overall mortality was 7.2% (18/251) of all the cases. The mortality was significantly higher in Group TACI (9.0%, 16/177) than that in Group TAMI (2.7%, 2/74) ( P <0.05). Conclusions TACI and TAMI have difference in clinical characteristics, injury severity and treatment results. It is a reliable way to evaluate the trauma severity of TACI and TAMI with RTS and PTI. To choose proper operative approach and prioritize the management sequence is important to increase the success rate of emergency treatment of TACI and TAMI.

关 键 词：胸部损伤 腹部损伤 穿透性损伤 多发伤 临床特点 手术入路 

分 类 号：R641[医药卫生—外科学]