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目的探讨严重胸腹部外伤并发肺不张的临床特点、诊断、治疗及预后。方法回顾分析舒兰矿业集团公司总医院2003年1月-2009年12月收治的严重胸腹外伤并发肺不张36例,其中,交通事故21例,砸伤6例,挤压伤4例,高空坠落伤3例,牛顶伤1例,爆炸伤1例。诊疗方法,通过望问触叩、穿刺、放射摄片、CT检查,根据检查结果判断胸腹损伤类型、损伤脏器部位以及严重程度。治疗以物理方法物化吸入为主,配合翻身、拍背、体位引流,常规氨溴索药物应用,治疗以3 d查看是否复张为基础,3 d后肺未复张或复张不全者使用纤维支气管镜治疗。结果全组病例均采用物理疗法及氨溴索治疗,25例肺不张3 d内好转,10例3 d内肺仍不张采用支气管镜治疗治愈,1例因连枷胸、脾破裂、十二指肠破裂,死于多器官功能衰竭。结论早期诊断与恰当治疗是提高肺不张治愈率的关键。
Objective To investigate the clinical features, diagnosis, treatment and prognosis of severe thoracoabdominal trauma complicated with atelectasis. Methods A retrospective analysis of Shulan Mining Group General Hospital January 2003 - December 2009 admitted to the severe chest and abdomen trauma complicated by atelectasis in 36 cases, of which 21 cases of traffic accidents, bruised in 6 cases, crush injury in 4 cases, 3 cases of altitude fall injury, 1 case of head injury, blast injury in 1 case. Diagnosis and treatment methods, by looking ask touch, puncture, radiography, CT examination, according to the test results to determine the type of chest and abdomen injury, damage to the site and the severity of organs. Physical therapy based on physical therapy inhalation, with stand up, shoot back, body position drainage, conventional ambroxol drug application, treatment to 3 d to see whether the expansion of the basis, 3 d after lung failure or incomplete re-use of fiber Bronchoscopy. Results All the patients were treated with physical therapy and ambroxol, 25 cases of atelectasis improved within 3 days, 10 cases of lung atelectasis were cured with bronchoscopy in 3 days, 1 case was due to flail chest, splenic rupture, 12 The intestine ruptures and dies in multiple organ failure. Conclusions Early diagnosis and proper treatment are the keys to improve the cure rate of atelectasis.