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成人胸部穿透伤的初始评估和处理

Authors
Julie Mayglothling, MD, FACEP, FCCM
Eric Legome, MD
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
周学武, 副教授

引言

胸部穿透伤的表现千差万别，有些患者病情稳定、主诉很少，而有些患者血流动力学不稳定、需要立即采取干预措施挽救生命。即使是表面上稳定的胸部穿透伤患者，病情也会陡然恶化，必须迅速进行重点深入的评估，以评估危及生命的疾病。

本专题将讨论胸部穿透伤成人所遭受损伤的流行病学、发生机制和初始处理的一般方法。钝性胸部伤、儿童胸部伤和具体损伤的确定性治疗见其他专题。 (参见“成人钝性胸部损伤的初步评估和处理”和“初步评估和稳定胸部创伤儿童”)

流行病学

胸部穿透伤通常较钝性胸部伤少见但更加致命。根据小型回顾性研究，在创伤患者中，胸部损伤是可预防性死亡相对常见的原因[1,2]。胸壁穿透伤最常见于枪弹伤和刺伤，在美国分别占所有严重创伤的高达10%和9.5%[3]。胸部穿透伤的其他原因包括：工业事故、坠落、碰撞、爆炸伤和爆碎性军事设备引起的物体刺伤。

胸部穿透伤的发生率存在地理差异。在美国，9%的所有创伤相关死亡由胸部损伤导致，其中1/3涉及穿透伤[4,5]。据报道，欧洲穿透伤的发生率低至4%[6]。然而，在发生战争的国家或地区，高达95%的军事死亡可由穿透伤导致[7]。在城市中心，人际间暴力冲突的发生率较高，相应地发生穿透伤的比例也比农村地区高。

大多数胸部穿透伤不需要大型手术治疗，许多患者被安排接受观察和放射影像学连续评估，或者单纯进行管式胸膜腔造口术。大约15%-30%的胸部穿透伤需要手术治疗，相比之下，钝性胸部创伤所致损伤的手术率则不足10%。

                                      

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-01.
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