胸外伤,1,Incidence and mortality发生率和死亡率: Chest trauma accounts for 8% occurrences of total traumatic cases, more than 25% of death caused by trauma.,Incidence proportion,Mortality proportion,胸外伤概况,2,胸外伤病因,Penetrating trauma贯穿伤,Blunt trauma 钝挫伤,车祸伤,坠落伤,挤压伤,刀刺伤,火器伤,3,Results from kinetic energy forces Blast（爆破伤） Pressure wave causes tissue disruption Tear blood vessels 55(3):190-5.,Revised Trauma Score RTS Trauma and Injury Severity Score TRISS Injury Severity Score ISS Lung Injury Scale LIS Chest Wall Injury Scale CWIS),152 patients with blunt thoracic trauma,assess,only TRISS was an independent predictor of mortality only LIS was an independent predictor of morbidity, the need for thoracotomy, and tube thoracostomy duration. TRISS and LIS were independent predictors of the length of ICU stay. ISS, CWIS, and LIS were independent predictors of the need for mechanical support. RTS, TRISS, ISS and LIS were independent predictors of the length of hospital stay.,CONCLUSIONS: The LIS grade appeared to correlate with the severity of blunt thoracic injury and was found to be the most useful scoring system in predicting the outcomes of these patients,28,结论：PTTCS方法对PTT结局的预测效果优于RTS。,胸部穿透伤进程评分 (PTTCS) 修订创伤评分（RTS）,梁贵友; 石应康; 杨建; 张尔永;胸部穿透伤损伤严重度新评分方法初探 .中华创伤杂志，2005,1 018例胸部穿透伤患者,assess,新评分方法的数学模型为： 与 RTS比较，PTTCS预测PTT结局的敏感性、特异性和准确性显著提高，死亡误判率明显降低。PTTCS分值与患者的死亡率呈现明显的负相关关系。,29,胸外伤的诊断,30,诊断方法：,诊断性胸腔穿刺 诊断性心包穿刺,X-ray CT 超声,31,32,胸外伤种类的诊断 依据辅助检查和查体可以完成。 严重程度诊断 ？ 指导治疗措施的选择,急诊剖胸探查,单纯胸腔闭式引流,无需特殊处理,33,胸外伤的治疗,34,呼吸支持 气管插管或气管切开，呼吸机辅助呼吸 气胸处置 出血处置 合并伤处置 先重后轻，先急后缓的原则,胸外伤处理的基本原则,AUSCULTATE! AUSCULATE! AUSCULATE!,35,Chest wall injury,稳定断端 包扎固定 牵引固定 内固定 止痛,36,VATS在胸外伤诊治中的应用,气胸、血胸、血管损伤的诊断和治疗。,37,Thanks,38,