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目的探讨影响创伤性膈肌破裂临床诊断和治疗效果的因素。方法收集自2003年6月-2008年12月诊治的52例创伤性膈肌破裂(TRD)患者的临床资料,对其发病原因、部位、合并伤及损伤严重度评分、诊断经过及手术途径等分别进行分析。结果胸腹部开放性损伤为本组患者的主要损伤(76.9%),早期诊断或延迟诊断对病情的转归影响显著。合并伤的伤情严重度是决定患者死亡与否的重要因素之一。与早期确诊相比,延迟诊断病例的术后并发症增多,早期诊断平均住院时间分别为11d,延迟诊断住院21.8d,差别有高度显著性(P<0.01)。结论术前对膈肌损伤认真检查是早期诊断的关键,胸部X线检查是首要的诊断方法,CT、MRI及床旁B超是可靠的诊断方法。避免延迟诊断及选择正确手术途径是提高抢救成功率的关键。
Objective To explore the factors influencing the clinical diagnosis and treatment of traumatic diaphragmatic rupture. Methods The clinical data of 52 patients with traumatic diaphragmatic rupture (TRD) who were diagnosed and treated from June 2003 to December 2008 were collected. The causes, locations, combined injury and severity of injury, diagnosis and surgical approach were collected Analyze. Results The open injury in the chest and abdomen was the main injury in this group (76.9%). The early diagnosis or delayed diagnosis had a significant effect on the prognosis of the patients. The severity of the injury associated with the injury is one of the important determinants of the patient’s death or not. Compared with the early diagnosis, delayed diagnosis of postoperative complications increased, the average early diagnosis of hospitalization was 11d, delayed diagnosis of hospitalization 21.8d, the difference was highly significant (P <0.01). Conclusion Preoperative diagnosis of diaphragmatic injury is the key to early diagnosis. Chest X-ray examination is the primary diagnostic method. CT, MRI and bedside B-ultrasound are reliable diagnostic methods. To avoid delay in diagnosis and selection of the correct surgical approach is to improve the success rate of rescue key.