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1、胸外傷進展瀘州醫(yī)學院附屬醫(yī)院于風旭Incidenceandmortality:Chesttraumaaccountsfor8%occurrencesoftotaltraumaticcases,morethan25%ofdeathcausedbytrauma.IncidenceproportionMortalityproportion胸外傷概況胸外傷病因PenetratingtraumaBlunttrauma車禍傷墜落傷擠壓傷刀刺傷火器傷ResultsfromkineticenergyforcesBlast（爆破傷）Pressur
2、ewavecausestissuedisruptionTearbloodvessels&disruptalveolartissueDisruptionoftracheobronchialtreeTraumaticdiaphragmruptureCrush(Compression)（擠壓傷）BodyiscompressedbetweenanobjectandahardsurfaceDirectinjuryofchestwallandinternalstructuresDeceleration（減速傷）Bodyinmotionstr
3、ikesafixedobjectBlunttraumatochestwallInternalstructurescontinueinmotionLigamentumArteriosumshearsaortaBluntTrauma壓力波造成組織破壞 撕裂血管，破壞肺泡組織 破壞氣管支氣管樹創(chuàng)傷性膈肌破裂胸外傷病理生理LowEnergyArrows,knives,handgunsInjurycausedbydirectcontactandcavitationHighEnergyMilitary,huntingrifles&highp
4、oweredhandgunsExtensiveinjuryduetohighpressurecavitationPenetratingTrauma穿透傷合并損傷ClosedpneumothoraxOpenpneumothoraxTensionpneumothoraxPneumomediastinumHemothoraxHemopneumothoraxLacerationofvascularstructures閉合性氣胸 開放性氣胸 張力性氣胸 氣腫 血胸 血氣胸 血管損傷Tracheobronchialtreelaceratio
5、nsEsophageallacerationsPenetratingcardiacinjuriesPericardialtamponadeSpinalcordinjuriesDiaphragmtraumaIntra-abdominalpenetrationwithassociatedorganinjury氣管支氣管樹裂傷 食管裂傷 穿透性心臟損傷 心包填塞 脊髓損傷 膈肌損傷傷 腹腔內(nèi)臟器損傷穿透傷合并損傷胸外傷詳細分類及病理生理改變Chestwallcontusionsorhematomas胸壁挫傷或血腫Ribfracture
6、s肋骨骨折Flailchest連枷胸Sternalfractures胸骨骨折Fracturesoftheshouldergirdle肩胛帶骨折InjuriestothechestwallContusionDyspneaPainonbreathingHypoventilationCrepitusParadoxicalchestwallmotion呼吸困難 呼吸疼痛 通氣不足 捻發(fā)音 胸壁矛盾運動RibFractures>50%ofsignificantchesttraumacasesduetoblunttraumaCompress
7、ionalforcesflexandfractureribsatweakestpointsRibs1-3requiresgreatforcetofracturePossibleunderlyinglunginjuryRibs4-9aremostcommonlyfracturedRibs9-12lesslikelytobefracturedTransmitenergyoftraumatointernalorgansIffractured,suspectliverandspleeninjuryHypoventilationisCOM
8、MONduetoPAINSternalFracture&Dislocation（胸骨骨折和錯位）AssociatedwithseverebluntanteriortraumaDirectBlow(比如：方向盤)Incidence:5-8%Mortality:25
