刘宗志+霍承瑜+牛磊

（民航總医院心胸外科，北京 100123）

[摘 要] 目的：分析紧急剖胸术（Emergency thoracotomy，ET）在严重胸部创伤中的应用价值，探讨其手术指征。方法：分析行ET的120例严重胸部创伤患者资料，将接受急诊室ET的42例患者纳入急诊室组，将接受手术室ET的78例患者纳入手术室组。比较两组患者手术情况及预后，总结ET的临床价值及手术指征。结果：急诊室组ISS评分、术后死亡率高于手术室组，差异有统计学意义（P<0.05）；穿透伤患者死亡率组间比较，差异无统计学意义（P>0.05）。急诊室组存活患者术后并发症发生率为39.13%，与手术室组的41.38%比较，差异无统计学意义（P>0.05）。随访期间4例患者（均接受全肺切除）遗留中度肺功能障碍、右心功能不全，11例患者遗留轻度肺功能障碍，2例患者心电图复查可见心肌损害表现，其余64例患者均未见明显异常。结论：急诊室ET对钝性伤所致严重胸部创伤的治疗价值有限；严重胸部创伤患者ET术后死亡原因以严重心包压塞、失血性休克为主，对于符合上述手术指征或合并主要支气管损伤、空气栓塞者，应及时实施ET。

[关键词] 紧急剖胸术；胸部创伤；手术指征

中图分类号：R655 文献标识码：A 文章编号：2095-5200（2017）04-021-03

DOI：10.11876/mimt201704009

Application value and surgical indications of emergency thoracotomy in severe thoracic trauma LIU Zongzhi，HUO Chengyu，NIU Lei. （Department of thoracicsurgery，Civil Aviation General Hospital，Beijing 100123 China）

[Abstract] Objective： This study was designed to analyse the application value of emergency thoracotomy （ET） in severe thoracic trauma， and to explore its indications of operation. Methods： A total sample of 120 patients with severe thoracic trauma were analyzed. 42 patients who received ET of emergency department were included in the emergency room group， and 78 patients who received ET of operating room were included in the operating room group. The surgical conditions and prognosis of the two groups were compared， and the clinical value of ET and surgical indications were summed up. Results： The ISS score and postoperative mortality in the emergency room group were higher than those in the operating room group， the difference was statistically significant （P<0.05）； and there was no statistically significant difference in the mortality for penetrating between the two groups （P>0.05）. The incidence of postoperative complications was 39.13% in the survivors of the emergency room group and 41.38% in the operating room group， the difference was not statistically significant （P>0.05）. During the follow-up period， 4 patients （all undergoing pneumonectomy） had moderate pulmonary dysfunction， right ventricular dysfunction， 11 patients with mild pulmonary dysfunction， 2 patients with myocardial damage showed by ECG， the remaining 64 patients were no obvious exception. Conclusions： The effect of ET in treatment of severe thoracic trauma caused by blunt trauma is limited. The cause of death in patients with severe thoracic trauma after ET is mainly due to severe pericardial tamponade and hemorrhagic shock. For patients who meet the above surgical indications or complicated with severe bronchial injury and air embolism， should be timely implementation of ET.

[Key words] emergency thoracotomy； thoracic trauma； surgical indications

胸部创伤约占创伤的6%～10%，占交通事故伤的44%以上，患者死亡率仅次于颅脑损伤，约有半数创伤患者死亡原因与胸部创伤及其并发症有关[1]。严重胸部创伤以肋骨骨折、胸壁心肺损伤所致气胸、血胸或张力性气胸为主要表现，患者常伴有呼吸和循环功能障碍，病情凶险、死亡率高[2]。作为初期复……