Clinical Epidemiological Characteristics And Analysis Of Diagnosis And Treatment Of Patients With Severe Chest Trauma In Western Zhuhai

Objective: To analyze the epidemiological and clinical characteristics of patients with severe chest trauma in Western Zhuhai,summarize clinical experiences of diagnosis and treatment,and offer reference for successfully treating patients with severe chest trauma.Methods: Totally 267 patients with severe chest trauma treated in the cardiothoracic surgery,emergency department and intensive care unit in the Fifth Affiliated Hospital of Zunyi Medical University(Zhuhai)from October 1,2012 to September 30,2017 were divided into severe blunt chest trauma(SBCT)group and severe penetrating chest trauma(SPCT)group according to violence features.Statistical analysis was conducted in the clinical data including gender,age,occupation,injury cause,injury time,injury condition,situation of diagnosis and treatment,and therapeutic outcome,and the preferred therapeutic regimens for clinical diagnosis and treatment of various kinds of severe chest trauma were summarized after in combination with the clinical experiences of diagnosis and treatment of severe chest trauma of our hospital.Results: 1.Overall data:(1)totally 267 cases were collected,with 228 cases in SBCT group and 39 cases in SPCT group.(2)The male to female ratio of cases was 3.31:1,the age was(44.32±15.18)years,the age ranged from 41 to 60 years was the most predilection age bracket.(3)The most popular occupation of injuries was worker,which accounted for 46.44% of all patients.(4)The greatest number of injuries(34.46%)was occurred in the period of 12:00-17:59.(5)Totally 112 cases received operation,in which 21 cases were dead.2.Comparison between SBCT group and SPCT group:(1)the male-female ratio of SBCT group was lower than that of SPCT group(P=0.038).(2)The average age of SBCT group was larger than that of SPCT group(P?0.01).(3)Worker was the most frequently occurred one(48.68%)in SBCT group,the occurrence in unemployed person was the highest in SPCT group(46.15%).(4)The greatest number of injuries was occurred in the period of 12:00-17:59 in SBCT group and 0:00-5:59 in SPCT group,respectively.The difference in the distribution of injury time between the two groups was statistically significant(P<0.01).(5)The traffic accident injuries and knife puncture injuries happened mostly in SBCT group(48.25%)and SPCT group(89.74%).(6)The rib fracture and pulmonary contusion were the most common injuries in SBCT group;the hemopneumothorax(left more than right)and pulmonary laceration were the most frequent injuries in SPCT group;the occurrence rate of associated injuries in SBCT group was higher than that in SPCT group(P=0.02);the ISS score of SBCT group was higher than that of SPCT group(P<0.01).(7)The number of patients who underwent operation was 73 cases in SBCT group and 39 cases in SPCT group,respectively.(8)In SBCT group,108 cases recovered,81 cases improved,17 cases died,18 cases transferred to another hospital,the cause of death included traumatic shock,acute respiratory failure,multiple organ dysfunction syndrome,cerebral hernia,and DIC.In SPCT group,37 cases recovered,2 cases died,and the death was caused by hemorrhagic shock.Conclusions: 1.The severe chest trauma in the western Zhuhai is mainly caused by blunt injury.The SBCT is more often appeared in men in the prime of life and worker,the most common type is traffic accident injuries,the SBCT happens mostly in the period of 12:00-17:59,the main symptoms are rib fracture and pulmonary contusion,and associated injuries are frequent.2.The SPCT in Western Zhuhai is more frequently appeared in young male and unemployed person,the most common type is knife penetrating injuries,the SPCT occurs mostly in the period of 0:00-5:59,the major symptoms are hemopneumothorax and pulmonary laceration,and associated injuries are relatively rare.3.The treatment for severe chest trauma emphasizes a simultaneous diagnosis and treatment.Most patients with severe blunt chest trauma can save lives by timely and effective non-surgical treatment,and surgical treatment is beneficial to the recovery of patients with severe chest wall trauma.However,penetrating chest trauma patients need more positive operation rescue treatment,timely and effective control of hemorrhagic shock is the key to treatment.