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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,创伤性血气胸的紧急处理,与转诊,中南大学湘雅二医院胸心外科胡建国陈名久,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,概述,口创伤性气胸根据胸膜腔是否与外界相通分为,开放性气胸:,多由锐器刺穿胸壁造成,空气由胸壁伤口自,由出入胸腔,影响呼吸循环功能。,闭合性气胸,多由于挤压、冲撞、钝器碰击胸部引起,常,伴有肋骨骨折,胸膜腔与外界不通或通道己,闭塞。,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,概述,当肺的裂伤较大或支气管破裂,其裂口与,胸膜腔相通,且形成活瓣时,易产生张力,性气胸,引起呼吸和循环功能的严重障碍,由于肺组织的裂伤、胸壁或胸内血管、心,脏的损伤导致胸腔内积血、积气称为血气,胸,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,临床表现,主要症状:胸痛呼吸困难,咯血,局部体征:有肋骨骨折者局部压痛,甚至胸,廓畸形,反常呼吸运动,皮下气肿,甚至气,管偏移。胸部叩诊积气呈鼓音,积血呈浊,音。听诊呼吸音减弱或消失胸壁伤口开,放者能听到空气出入胸膜腔的吹风声。,大量出血时可出现休克,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,断,仔细询问胸部外伤史了解受伤机制,体查:胸廓有无畸形,胸壁有无压痛,叩诊,情况,听诊呼吸音及心音、心率,胸部X片(条件允许时应照),尽可能采用立,位,了解有无肋骨骨折或血气胸以及肺组织,有无挫伤,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,断,有时在伤后的最初几小时内,胸部X检查可,能无阳性发现,必要时复查胸部X片,以免,延误治疗,在危急情况下,应先作诊断性穿刺,胸膜,腔抽出不凝固血液或气体即能明确诊断。,锐器伤的病人应注意创口位置,警惕心脏,和大血管的损伤以及胸腹联合伤。必要时,应作胸部CT及心脏彩超检查,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,闭合性气胸( losed Pneumothor ax),临床表现,肺萎陷在30%以下者,对,呼吸和循环功能影响较小,多无明显症状,大量气胸(压缩50%以,病人出现胸闷、胸痛,和气促,气管向健侧移位,伤侧胸部叩诊呈鼓音,听诊,呼吸音减弱或消失,胸部X线检查有助于诊断,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,闭合性气胸( Closed pneumothora ax),治疗,小量气胸(压缩30%),勿需特殊处理,胸内,积气一般可在12W内自行吸收,中量气胸(压缩30%509)胸穿抽气复查胸,片,口大量气胸需行胸穿抽气或胸膜腔闭式引流术,促使肺尽早膨胀,并使用抗生素预防感染,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,Chest tube,Pneumothorax,Re-expanded lung,adam. com,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,开放性气胸 Open Pneumothorax,病理生理,伤侧胸膜腔负压消失,肺萎陷,纵隔移位,健侧,肺扩张受限,纵隔扑动能影响静脉回流,引起循环障碍,反常呼吸:含氧低气体在两侧肺内重复交换将造,成严重缺氧,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,
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