现代战争胸部战伤救治需求分析及对策建议
摘要
通过文献调研分析了解历次现代战争中胸部战伤的发生情况。胸部战伤以爆炸致伤为主,损伤严重程度增高,伤死率居高不下。其中致死率较高的损伤依次为胸部大血管损伤、连枷胸及心脏损伤等。在救治策略上应体现分级救治和损伤控制原则,在现场急救中处理气胸;在紧急救治中对连枷胸、血胸和心脏压塞伤员进行识别和干预,合理施行胸腔置管术;在早期救治中对伤死率较高的损伤进行必要的治疗,合理施行紧急开胸术。本文结合我军战伤救治体系,提出了早期各阶段胸部战伤救治的对策建议。
引文
[1]Smith JE.The epidemiology of blast lung injury during recent military conflicts:A retrospective database review of cases presenting to deployed military hospitals,2003-2009[J].Philos Trans R Soc Lond B Biol Sci,2011,366(1562):291-294.
[2]Morrison J,Midwinter M,Jansen J.Ballistic thoracoabdominal injury:Analysis of recent military experience in Afghanistan[J].World J Surg,2011,35(6):1396-1401.
[3]Bonnet S,Gonzalez F,Poichotte A,et al.Lessons learned from the experience of visceral military surgeons in the french role 3medical treatment facility of Kabul(Afghanistan):An extended skill mix required[J].Injury,2012,43(8):1301-1306.
[4]Edens J,Chung K,Pamplin J,et al.Predictors of early acute lung injury at a combat support hospital:A prospective observational study[J].J Trauma,2010,69(Suppl 1):S81-S86.
[5]Butler FK Jr,Blackbourne LH.Battlefield trauma care then and now:A decade of tactical combat casualty care[J].J Trauma Acute Care Surg,2012,73(Suppl 5):S395-S402.
[6]Orman JA,Eastridge BJ,Baer DG,et al.The impact of 10years of war on combat casualty care research:A citation analysis[J].J Trauma Acute Care Surg,2012,73(Suppl 5):S403-S408.
[7]Senanayake EL,Poon H,Graham TR,et al.UK specialist cardiothoracic management of thoracic injuries in military casualties sustained in the wars in Iraq and Afghanistan[J].Eur J Cardiothorac Surg,2014,45(6):e202-e207.
[8]Poon H,Morrison JJ,Apodaca AN,et al.The UK military experience of thoracic injury in the wars in Iraq and Afghanistan[J].Injury,2013,44(9):1165-1170.
[9]Ivey KM,White CE,Wallum TE,et al.Thoracic injuries in US combat casualties:A 10-year review of operation enduring freedom and Iraqi freedom[J].J Trauma Acute Care Surg,2012,73(Suppl 5):S514-S519.
[10]Keneally R,Szpisjak D.Thoracic trauma in Iraq and Afghanistan[J].J Trauma Acute Care Surg,2013,74(5):1292-1297.
[11]Edens JW,Beekley AC,Chung KK,et al.Long term outcomes after combat casualty emergency department thoracotomy[J].J Am Coll Surg,2009,209(2):188-197.
[12]Bird SM,Fairweather CB.Military fatality rates(by cause)in Afghanistan and Iraq:A measure of hostilities[J].Int J Epidemiol,2007,36(4):841-846.
[13]Tarmey NT,Park CL,Bartels OJ,et al.Outcomes following military traumatic cardiorespiratory arrest:A prospective observational study[J].Resuscitation,2011,82(9):1194-1197.
[14]West JP.Chest wounds in battle casualties[J].Ann Surg,1945,121(6):833-839.
[15]Molnar TF,Hasse J,Jeyasingham K,et al.Changing dogmas:History of development in treatment modalities of traumatic pneumothorax,hemothorax,and posttraumatic empyema thoracis[J].Ann Thorac Surg,2004,77(1):372-378.
[16]McNamara JJ,Messersmith JK,Dunn RA,et al.Thoracic injuries in combat casualties in vietnam[J].Ann Thorac Surg,1970,10(5):389-401.
[17]Lesquen HD,Beranger F,Berbis J,et al.Challenges in war-related thoracic injury faced by french military surgeons in Afghanistan(2009-2013)[J].Injury,2016,47(9):1939-1944.
[18]Parker P,Trauma-Working G.Consensus statement on decision making in junctional trauma care[J].J Royal Army Med Corps,2011,157(Suppl 1):S293-S295.
[19]Gerhardt RT,Berry JA,Blackbourne LH.Analysis of life-saving interventions performed by out-of-hospital combat medical personnel[J].J Trauma,2011,71(Suppl 1):S109-S113.
[20]Hodgetts TJ,Mahoney PF,Kirkman E.Damage control resuscitation[J].J R Army Med Corps,2007,153(4):299-300.
[21]Chen J,Nadler R,Schwartz D,et al.Needle thoracostomy for tension pneumothorax:The Israeli defense forces experience[J].Can J Surg,2015,58(Suppl 3):S118-S124.
[22]Zakharia AT.Thoracic battle injuries in the Lebanon war:Review of the early operative approach in 1992patients[J].Ann Thorac Surg,1985,40(3):209-213.
[23]Biocina B,Sutlic′Z,Husedzinovic′I,et al.Penetrating cardiothoracic war wounds[J].Eur J Cardiothorac Surg,1997,11(3):399-405.
[24]Smith JE.The epidemiology of blast lung injury during recent military conflicts:A retrospective database review of cases presenting to deployed military hospitals,2003-2009[J].Philos Trans R Soc Lond B Biol Sci,2011,366(1562):291-294.
[25]Bird SM,Fairweather CB.Military fatality rates(by cause)in Afghanistan and Iraq:A measure of hostilities[J].Int J Epidemiol,2007,36(4):841-816.
[26]Debakey ME,Carter BN.Current considerations of war surgery[J].Ann Surg,1945,121(5):545-563.
[27]Bellamy RF.History of surgery for penetrating chest trauma[J].Chest Surg Clin N Am,2000,10(1):55-70,viii.
[28]McNamara JJ,Messersmith JK,Dunn RA,et al.Thoracic injuries in combat casualties in vietnam[J].Ann Thorac Surg,1970,10(5):389-401.
[29]总后勤部卫生部.战伤救治规则[M].北京:解放军出版社,2006:32-33.
[2]Morrison J,Midwinter M,Jansen J.Ballistic thoracoabdominal injury:Analysis of recent military experience in Afghanistan[J].World J Surg,2011,35(6):1396-1401.
[3]Bonnet S,Gonzalez F,Poichotte A,et al.Lessons learned from the experience of visceral military surgeons in the french role 3medical treatment facility of Kabul(Afghanistan):An extended skill mix required[J].Injury,2012,43(8):1301-1306.
[4]Edens J,Chung K,Pamplin J,et al.Predictors of early acute lung injury at a combat support hospital:A prospective observational study[J].J Trauma,2010,69(Suppl 1):S81-S86.
[5]Butler FK Jr,Blackbourne LH.Battlefield trauma care then and now:A decade of tactical combat casualty care[J].J Trauma Acute Care Surg,2012,73(Suppl 5):S395-S402.
[6]Orman JA,Eastridge BJ,Baer DG,et al.The impact of 10years of war on combat casualty care research:A citation analysis[J].J Trauma Acute Care Surg,2012,73(Suppl 5):S403-S408.
[7]Senanayake EL,Poon H,Graham TR,et al.UK specialist cardiothoracic management of thoracic injuries in military casualties sustained in the wars in Iraq and Afghanistan[J].Eur J Cardiothorac Surg,2014,45(6):e202-e207.
[8]Poon H,Morrison JJ,Apodaca AN,et al.The UK military experience of thoracic injury in the wars in Iraq and Afghanistan[J].Injury,2013,44(9):1165-1170.
[9]Ivey KM,White CE,Wallum TE,et al.Thoracic injuries in US combat casualties:A 10-year review of operation enduring freedom and Iraqi freedom[J].J Trauma Acute Care Surg,2012,73(Suppl 5):S514-S519.
[10]Keneally R,Szpisjak D.Thoracic trauma in Iraq and Afghanistan[J].J Trauma Acute Care Surg,2013,74(5):1292-1297.
[11]Edens JW,Beekley AC,Chung KK,et al.Long term outcomes after combat casualty emergency department thoracotomy[J].J Am Coll Surg,2009,209(2):188-197.
[12]Bird SM,Fairweather CB.Military fatality rates(by cause)in Afghanistan and Iraq:A measure of hostilities[J].Int J Epidemiol,2007,36(4):841-846.
[13]Tarmey NT,Park CL,Bartels OJ,et al.Outcomes following military traumatic cardiorespiratory arrest:A prospective observational study[J].Resuscitation,2011,82(9):1194-1197.
[14]West JP.Chest wounds in battle casualties[J].Ann Surg,1945,121(6):833-839.
[15]Molnar TF,Hasse J,Jeyasingham K,et al.Changing dogmas:History of development in treatment modalities of traumatic pneumothorax,hemothorax,and posttraumatic empyema thoracis[J].Ann Thorac Surg,2004,77(1):372-378.
[16]McNamara JJ,Messersmith JK,Dunn RA,et al.Thoracic injuries in combat casualties in vietnam[J].Ann Thorac Surg,1970,10(5):389-401.
[17]Lesquen HD,Beranger F,Berbis J,et al.Challenges in war-related thoracic injury faced by french military surgeons in Afghanistan(2009-2013)[J].Injury,2016,47(9):1939-1944.
[18]Parker P,Trauma-Working G.Consensus statement on decision making in junctional trauma care[J].J Royal Army Med Corps,2011,157(Suppl 1):S293-S295.
[19]Gerhardt RT,Berry JA,Blackbourne LH.Analysis of life-saving interventions performed by out-of-hospital combat medical personnel[J].J Trauma,2011,71(Suppl 1):S109-S113.
[20]Hodgetts TJ,Mahoney PF,Kirkman E.Damage control resuscitation[J].J R Army Med Corps,2007,153(4):299-300.
[21]Chen J,Nadler R,Schwartz D,et al.Needle thoracostomy for tension pneumothorax:The Israeli defense forces experience[J].Can J Surg,2015,58(Suppl 3):S118-S124.
[22]Zakharia AT.Thoracic battle injuries in the Lebanon war:Review of the early operative approach in 1992patients[J].Ann Thorac Surg,1985,40(3):209-213.
[23]Biocina B,Sutlic′Z,Husedzinovic′I,et al.Penetrating cardiothoracic war wounds[J].Eur J Cardiothorac Surg,1997,11(3):399-405.
[24]Smith JE.The epidemiology of blast lung injury during recent military conflicts:A retrospective database review of cases presenting to deployed military hospitals,2003-2009[J].Philos Trans R Soc Lond B Biol Sci,2011,366(1562):291-294.
[25]Bird SM,Fairweather CB.Military fatality rates(by cause)in Afghanistan and Iraq:A measure of hostilities[J].Int J Epidemiol,2007,36(4):841-816.
[26]Debakey ME,Carter BN.Current considerations of war surgery[J].Ann Surg,1945,121(5):545-563.
[27]Bellamy RF.History of surgery for penetrating chest trauma[J].Chest Surg Clin N Am,2000,10(1):55-70,viii.
[28]McNamara JJ,Messersmith JK,Dunn RA,et al.Thoracic injuries in combat casualties in vietnam[J].Ann Thorac Surg,1970,10(5):389-401.
[29]总后勤部卫生部.战伤救治规则[M].北京:解放军出版社,2006:32-33.