【摘要】目的：探讨胸外伤后急性呼吸衰竭(ARF)的规范化防治与病因分析方法以改善患者预后。方法：回顾性分析我院1997年7月-2009年1月收治316例胸外伤的病例资料，伤后急性呼吸衰竭38例(12%)。伴有休克或(和)心电图异常21例，昏迷9例，肾功能障碍8例和肝功能障碍7例。结果：死亡4例，死亡率10.5%。ARF随着合并功能障碍脏器数目的增多，死亡的危险性明显增多。结论：及早预防和处理ARF和脏器功能障碍，是降低胸外伤死亡率的关键，提出按照主要病因和发病机理将胸外伤后ARF分为：①外呼吸障碍；②肺挫伤；③继发性病因所致三类呼衰的分类方法。第③类ARF的死亡率最高。

    【关键词】胸外伤；急性呼吸衰竭

    Treatment strategy and analysis of etiology for acute respiratory failure after chest trauma

    PAN Chuan-yongLIU Ji-fangLIAN Shu-jian

    【Abstract】Objective To investigate standardized treatment strategy and analysis of etiology in patients with chest trauma with secondary acute respiratory failure (ARF) in order to improve the outcome of patients. Methods Clinical records of 316 patients with chest trauma were retrospectively analyzed from July 1997 to January 2009 in our hospital. 38 (12%) patients had secondary ARF, 21 patients underwent stroke and/or abnormal ECG, 9 patients had coma, 8 patients had liver dysfunction and 7 patients had kidney dysfunction. Results 4 patients died, the rate of death was 10.5%. The risk of death was associated with the number of organs with functional impairment. Conclusion Prevention and treatment of ARF and organs dysfunction are key points of reduction of death rate. Chest trauma with secondary ARF is classified into three forms according to main etiology and pathogenesis:① impairment of external respiration；② pulmonary contusion；③ ARF subsequent to pulmonary contusion, and③ARF due to secondary pathogenic causes. The third type of ARF is usually associated with the highest mortality rate. ......