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目的:总结创伤性膈肌破裂的临床特点及诊治经验。方法:58例患者分为闭合伤组和穿透伤组,分析患者临床资料,并运用多种创伤评分法,进行损伤严重程度的评估。结果:闭合性膈肌破裂常并发全身多发伤,病情复杂,漏诊率(35.7%)及死亡率(21.4%)高;开放性损伤病情进展快,早期易出现失血性休克,但诊断较明确,预后好。比较两组的创伤评分,其中创伤严重度评分(ISS),改良创伤评分(RTS)及胸部简明创伤评分(AIS),两组间差异无统计学意义(P>0.05),但闭合伤组患者的格拉斯哥昏迷评分(GCS)和腹部简明创伤评分(AIS)较低(P<0.05)。结论:闭合性和开放性膈肌破裂在损伤机制、临床表现、诊断方法上存在明显的差异,临床上应针对损伤的不同类型,采取相应的诊断措施,提高救治率。而合理运用各种方法进行损伤严重度评分,有助于判断预后,评价救治水平。
Objective: To summarize the clinical features and diagnosis and treatment of traumatic diaphragmatic rupture. Methods: Fifty-eight patients were divided into closed injury group and penetrating injury group. The clinical data of the patients were analyzed, and the severity of the injury was evaluated by various trauma score methods. Results: The occlusive diaphragmatic rupture often complicated with multiple traumatic injuries, the condition is complicated, the rate of misdiagnosis (35.7%) and mortality (21.4%) are high. The open injury is progressing rapidly and hemorrhagic shock is easy to occur in the early stage. it is good. There was no significant difference between the two groups (P> 0.05). However, in the patients with closed injury group, the scores of trauma, ISS, RTS and AIS of the two groups were compared Glasgow coma scale (GCS) and abdominal plain trauma score (AIS) were lower (P <0.05). CONCLUSION: The closed and open diaphragmatic rupture have obvious differences in the mechanism of injury, clinical manifestation and diagnosis. Clinically, different types of lesions should be taken and corresponding diagnostic measures should be taken to improve the treatment rate. The rational use of various methods for the severity of injury score can help determine the prognosis and evaluate the level of treatment.