Either Hypotension or Clinical Signs Alone Is a Reliable Indication for Immediate Tube Thoracostomy in Penetrating Chest Injury

休克或臨床徵象是穿刺性胸部外傷一個立即插胸管的可靠指標

陳石池(Shyr-Chyr Chen) ； 柯得(Donal R. Kauder)

《慈濟醫學雜誌》 8卷4期 (1996/12) Pp. 263-269

https://doi.org/10.6440/TZUCMJ.199612.0263

摘要

在261穿刺性胸部外傷病人中，41位(15.7%)發生休克，其中38位(92.7%)有氣胸或血胸。休克的病人發生氣胸或血胸的機會，受傷程度，住院天數和死亡率都比未休克者高。以聽診來檢查氣胸或血胸的敏感度為62.2%，精密度為98.1%，準確度為77.0%，正預測值為98.0%，我們認為在穿刺性胸部外傷發生休克或聽診發現肺部呼吸聲減少或消失時，在照胸部X光前可做為插胸管的指標。(慈濟醫學1996; 8:263-269)

關鍵字

休克 ； 血氣胸 ； 插胸管 ； 穿刺性胸部外傷

並列摘要

We tried to study the relationship between hypotension, clinical findings and hemopneumothorax in penetrating chest injury to determine whether hypotension or clinical findings alone in penetrating chest injury is a reliable indicator for immediate tube thoracostomy. All patients(n=310) with penetrating chest injury admitted to a level I university affiliated trauma center over a two-year period were evaluated. Systolic blood pressure, clinical findings on primary survey and chest x-ray for the presence of hemothorax, pneumothorax or hemopneumothorax were compared. The statistical differences were determined by the Student’s t-test. Of 310 patients, 49 patients died in the trauma bay without chest x-ray, leaving 261 patients. A total of 155 patients (59.4%) had a lesion of hemothorax, peneumothorax, or hemopeumothorax an chest x-ray treated with tube thoracostomy. Hypotension was present in 41 patients (15.75) and hemothorax, pneumothorax, and hemopneumothorax was present in 38 of these 41(92.7%). Hypotension was associated with longer hospital stay, higher mortality an higher Injury Severity Score. Auscultation to detect hemothorax, pneumothorax or hemopneumothorax had a sensitivity of 62.6%, a specificity of 98.1%, an accuracy of 77.0%, and a positive predictive value of 98.0%. Penetrating chest injury with hypotension or decreased breathing sounds alone has a significant incidence of hemothorax, pneumothorax, or hemopneumothorax on the side of the injured hemothorax. We conclude that immediate tube thoracostomy before chest x-ray is warranted.(Tzu Chi Med J 1996; 8: 263-269)

並列關鍵字

hypotension ； hemopneumothorax ； tube thoracostomy ； penetrating chest injury