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目的:探讨严重胸外伤合并颅脑伤的临床特点及早期诊治。方法:按损伤严重度评分法(Iss),对72例 ISS≥20分,严重胸部损伤合并颅脑伤患者,采取各种诊治措施,除抗休克、紧急气管插管或切开外,行胸腔闭式引流70例,剖胸探查19例,呼吸机辅助呼吸+PEEP42例。结果:本组死亡30例,病死率41.7%,其中 ISS 值20～60分死亡19例,11例 ISS 值≥61分者无一例存活。结论:严重胸外伤合并颅脑伤均存在休克,呼吸困难,昏迷等危重情况,病死率高。胸腔穿刺,胸腔闭式引流,气管插管或切开,机械辅助呼吸+PEEP,尽早使用脱水剂或开颅减压是早期判断病因,进行鉴别诊断最简便确切的手段,也是最有效的早期治疗措施。
Objective: To investigate the clinical features and early diagnosis and treatment of severe thoracic trauma combined with craniocerebral injury. Methods: Seventy-two ISS patients with ISS≥20 and severe thoracic injury with craniocerebral injury were enrolled in this study according to the severity of injury (Iss). Various diagnostic and therapeutic measures were taken except for anti-shock, emergency intubation or incision, 70 cases of drainage, thoracotomy exploration in 19 cases, ventilator-assisted breathing + PEEP42 cases. Results: There were 30 deaths in this group with a mortality rate of 41.7%. There were 19 deaths with ISS ranging from 20 to 60 points and none of 11 patients with ISS ≥61. Conclusion: Severe thoracic injury combined with craniocerebral injury both in critical condition such as shock, dyspnea and coma, and high mortality. Thoracentesis, closed thoracic drainage, tracheal intubation or incision, mechanical assisted breathing + PEEP, early use of dehydration agent or craniotomy decompression is the early diagnosis of the cause, the most simple and accurate differential diagnosis of the most accurate means, but also the most effective early treatment Measures.