CAJ | 학술논문

目的：探讨CT检查在钝性胸部外伤中的早期诊断价值。方法以系统回顾的方法，利用病案管理系统采集2005年3月至2011年6月因钝性胸部损伤就诊、并在早期进行胸部X线和CT检查的200例患者为研究对象。收集相关的人口统计学信息及诊疗信息，记录RTS外伤评分（Revised trauma score）。比较胸部X线和CT两者间在诊治方面的差异，评价胸部CT在钝性胸部外伤诊断和治疗中的影响力。结果200例患者先后进行胸部X线和CT检查，胸部X线检查异常者为149例，胸部CT检查异常者为186例，两种检查均未见异常为14例。两种检查方法比较发现，胸部CT在肋骨骨折、血胸、肺挫伤等病变诊断方面敏感性明显高于胸部X线（P＜0.05）。在实施胸腔闭式引流术、剖胸探查等诊疗操作的108例患者中，93例是CT检查前进行的，CT检查后实施的患者中9例X线已提示和CT检查结果相同的诊断。根据RTS外伤评分，RTS评分越低实施胸外治疗概率越高（P＜0.001）。结论胸部CT在血胸、肺挫伤、肋骨骨折等诊断方面较胸部X线检查具有更高的敏感性和精确性，但在决定性诊疗操作实施方面影响力显著降低，即 CT 诊断发现较多，但需要进一步治疗的却很少。因此，我们主张在无明显头部外伤、RTS 评分9分以上、生命体征稳定的患者，应选择性进行胸部CT检查。
목적：탐토CT검사재둔성흉부외상중적조기진단개치。방법이계통회고적방법，이용병안관리계통채집2005년3월지2011년6월인둔성흉부손상취진、병재조기진행흉부X선화CT검사적200례환자위연구대상。수집상관적인구통계학신식급진료신식，기록RTS외상평분（Revised trauma score）。비교흉부X선화CT량자간재진치방면적차이，평개흉부CT재둔성흉부외상진단화치료중적영향력。결과200례환자선후진행흉부X선화CT검사，흉부X선검사이상자위149례，흉부CT검사이상자위186례，량충검사균미견이상위14례。량충검사방법비교발현，흉부CT재륵골골절、혈흉、폐좌상등병변진단방면민감성명현고우흉부X선（P＜0.05）。재실시흉강폐식인류술、부흉탐사등진료조작적108례환자중，93례시CT검사전진행적，CT검사후실시적환자중9례X선이제시화CT검사결과상동적진단。근거RTS외상평분，RTS평분월저실시흉외치료개솔월고（P＜0.001）。결론흉부CT재혈흉、폐좌상、륵골골절등진단방면교흉부X선검사구유경고적민감성화정학성，단재결정성진료조작실시방면영향력현저강저，즉 CT 진단발현교다，단수요진일보치료적각흔소。인차，아문주장재무명현두부외상、RTS 평분9분이상、생명체정은정적환자，응선택성진행흉부CT검사。
Objective Blunt chest trauma accounts for 90%of all chest traumas in Europe and the United States and this causes 25% of all trauma-related deaths. The major cause of morbidity and mortality after blunt chest trauma is undetected injuries. For this reason, chest computerized tomography has gained popularity for the evaluation of trauma, but it is expensive and it exposes patients to radiation. This study identified the clinical features associated with the diagnostic information obtained on a CT chest scan, as compared with a standard chest X-ray, for patients who sustained blunt trauma to the chest. This study also evaluated the role of a routine computed tomographic (CT) scan for these patients. The patients who had chest computed tomography done after the initial chest x-ray were analyzed separately for the presence of occult injuries. Methods We studied 200 consecutive patients from March 2005 to June 2011. Simultaneous with the initial clinical evaluation, an anteroposterior chest radiograph and a helical chest CT scan were obtained for all the patients. The data extracted from the medical record included the vital signs, the interventions and the type and severity of injury RTS(revised trauma score,including Glasgow Coma scale,systolic BP and respiratory rate). Results Among the 200 cases, 149 patients showed at least more than one pathologic sign on their chest radiograph and 186 patients on chest CT. For 37 of the patients who had a normal chest X-ray, the CT scan showed multiple injuries, which were pneumothorax, hemothorax, lung contusion, sternal fracture etc. This represents that a CT scan was statistically superior to a chest radiograph to diagnose the pathologic signs. But on the other hand, as for treatment, total 108 patients were diagnosed by CT scan and they were treated with chest tube insertion or open thoracotomy, including 97 patients were treated based on the diagnosis made by the chest radiograph and physical examination. Conclusion Chest computerized tomography was significantly more effective than routine chest X-ray for detecting lung contusion, hemothorax and fractured ribs. Although the occult findings increased, the number of patients who needed treatment was small. Therefore, we suggest making selective use of a CT scan to avoid its overuse in ERs.