摘要
目的 报告 1 例胸部外伤致去皮质综合征患者,探讨胸部外伤与去皮质综合征的关系,为该类患者的救治积累经验,辅助判断预后.方法 庄浪县人民医院收治 1 例入院 2 d前胸部受伤且呈醒状昏迷状态患者,回顾并分析病史、诊治过程、疗效及预后.结果 患者入院2 d前被他人用木棒击伤右侧胸部,伤后出现胸痛、胸闷、气短,呈醒状昏迷状态,右侧胸壁有不规则青紫,查胸部CT提示右侧第 8 肋骨骨折,右侧胸腔积血(少量),双下肺炎症病变,诊断为去皮质综合征.入院后急给予清理呼吸道,面罩吸氧、抗休克、抗感染、雾化吸入、祛痰、纠正酸中毒、减轻肺水肿、改善微循环及脑水肿等综合治疗,3 d后患者生命体征平稳,转归良好.结论 由胸部外伤所致的去皮质综合征在短期内及时干预,纠正低氧血症、电解质紊乱、酸碱中毒和继发感染等问题,即使患者已出现去皮质综合征及呼吸窘迫综合征,也有望完全康复.
Abstract
Objective To report a patient with thoracic trauma induced decorticate syndrome,explore the relationship between thoracic trauma and decorticate syndrome,accumulate diagnostic and treatment experience,and assist in predicting prognosis.Methods Zhuanglang County People's Hospital admitted a patient with chest injury 2 days before admission and awaken coma.The medical history,diagnosis and treatment process,efficacy and prognosis were reviewed and analyzed.Results The patient's right chest was injured by others with a wooden stick 2 days ago.The patient had chest pain,chest tightness,shortness of breath after the injury,in awaken coma,and the whole body skin and mucous membranes in addition to the right side of the chest wall by the irregular bruising.Chest CT suggested that the right side of the eighth rib fracture,the right side of thoracic cavity blood(a small amount),double lower pneumonic lesions,and the patient was diagnosed with decorticate syndrome.After admission,the patient was urgently given comprehensive treatment such as clearing airway,mask oxygen,anti-shock,anti-infection,nebulized inhalation,expectoration,correction of acidosis,reduction of pulmonary edema,improvement of microcirculation and cerebral edema,etc.The patient's vital signs were stabilized after 3 days,and the outcome was good.Conclusion Decorticate syndrome due to chest trauma is expected to recover completely in the short term if timely intervention is made to correct the problems of hypoxemia,electrolyte disorders,acid-base intoxication and secondary infections,even if the patient has developed decorticate syndrome and respiratory distress syndrome.
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