胸部外伤课件_9

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1、胸外伤进展泸州医学院附属医院于风旭Incidenceandmortality:Chesttraumaaccountsfor8%occurrencesoftotaltraumaticcases,morethan25%ofdeathcausedbytrauma.IncidenceproportionMortalityproportion胸外伤概况胸外伤病因PenetratingtraumaBlunttrauma车祸伤坠落伤挤压伤刀刺伤火器伤ResultsfromkineticenergyforcesBlast（爆破伤）Pressur

2、ewavecausestissuedisruptionTearbloodvessels&disruptalveolartissueDisruptionoftracheobronchialtreeTraumaticdiaphragmruptureCrush(Compression)（挤压伤）BodyiscompressedbetweenanobjectandahardsurfaceDirectinjuryofchestwallandinternalstructuresDeceleration（减速伤）Bodyinmotionstr

3、ikesafixedobjectBlunttraumatochestwallInternalstructurescontinueinmotionLigamentumArteriosumshearsaortaBluntTrauma压力波造成组织破坏撕裂血管，破坏肺泡组织破坏气管支气管树创伤性膈肌破裂胸外伤病理生理LowEnergyArrows,knives,handgunsInjurycausedbydirectcontactandcavitationHighEnergyMilitary,huntingrifles&highp

4、oweredhandgunsExtensiveinjuryduetohighpressurecavitationPenetratingTrauma穿透伤合并损伤ClosedpneumothoraxOpenpneumothoraxTensionpneumothoraxPneumomediastinumHemothoraxHemopneumothoraxLacerationofvascularstructures闭合性气胸开放性气胸张力性气胸气肿血胸血气胸血管损伤Tracheobronchialtreelaceratio

5、nsEsophageallacerationsPenetratingcardiacinjuriesPericardialtamponadeSpinalcordinjuriesDiaphragmtraumaIntra-abdominalpenetrationwithassociatedorganinjury气管支气管树裂伤食管裂伤穿透性心脏损伤心包填塞脊髓损伤膈肌损伤伤腹腔内脏器损伤穿透伤合并损伤胸外伤详细分类及病理生理改变Chestwallcontusionsorhematomas胸壁挫伤或血肿Ribfracture

6、s肋骨骨折Flailchest连枷胸Sternalfractures胸骨骨折Fracturesoftheshouldergirdle肩胛带骨折InjuriestothechestwallContusionDyspneaPainonbreathingHypoventilationCrepitusParadoxicalchestwallmotion呼吸困难呼吸疼痛通气不足捻发音胸壁矛盾运动RibFractures>50%ofsignificantchesttraumacasesduetoblunttraumaCompress

7、ionalforcesflexandfractureribsatweakestpointsRibs1-3requiresgreatforcetofracturePossibleunderlyinglunginjuryRibs4-9aremostcommonlyfracturedRibs9-12lesslikelytobefracturedTransmitenergyoftraumatointernalorgansIffractured,suspectliverandspleeninjuryHypoventilationisCOM

8、MONduetoPAINSternalFracture&Dislocation（胸骨骨折和错位）AssociatedwithseverebluntanteriortraumaDirectBlow(比如：方向盘)Incidence:5-8%Mortality:25